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laparoscopic gastrectomy

  1. Default laparoscopic gastrectomy
    Medical Coding Books
    I'm new to GI coding. Physician performed laparoscopic partial gastrectomy to remove malignant lesion. Phyisician billed 43659, unlisted laparoscopy procedure. BCBS is denying the code and wanting a compatible code to replace it. Is there another code for this procedure?


  2. Default
    Would you please post the operative note of the procedure? Need more info to determine code.

  3. Default laparoscopic gastrectomy
    The patient was transferred to the operating room and placed on the
    operating table in the supine position. The patient was sedated and
    intubated without any complications. Her abdomen was then prepped and
    draped in a sterile fashion. We did start with the placement of a 5 mm port
    just above the umbilicus using the Optiview technique under direct
    visualization. The port was placed without any complications. A
    pneumoperitoneum was obtained. We then visualized the stomach and were
    trying to evaluate for the area that was tattooed by the
    gastroenterologist. We did note that there was what appeared to be color
    change along the greater curve of the antrum, however, this looked to be on
    the underside of the stomach. To better evaluate this, we went ahead and
    performed an EGD intraoperatively to confirm where the site of the tattoo
    was, as well as the lesion. This area was transilluminated and was easily
    visualized laparoscopically. We then placed an additional 5 mm trocar in
    the right upper quadrant and 2 further trocars, 1 immediately above the
    umbilicus and 1 in the left upper quadrant. We were able to mobilize the
    gastrocolic ligament with the Harmonic scalpel, exposing the posterior
    aspect of the stomach along the antrum. Using guidance with the EGD, we
    were able to grasp the lesion with a Prestige grasper and noted the entire
    lesion within our grasper through the EGD. At this point in time, we were
    able to upsize our left upper quadrant port to a 12 mm trocar and, using a
    60 flex HD Ethicon stapler with green loads and Peri-Strips, we were able
    to wedge out the lesion with 4 fires of the stapler. We ensured that there
    was no stricturing of the pylorus. We then rescoped her stomach with no
    findings of any complications. There was bluish demarcation of the mucosa
    where the line of our staplers were.
    We sent the specimen immediately to pathology. They opened the specimen
    immediately and noted that there was an area of tattoo, however, did not
    immediately see the lesion. On inspection by Dr. Derrick, he felt that the
    lesion was within the specimen, as well as potentially the staple line. No
    lesion was noted on EGD.
    The decision was made at this time to complete the procedure. Hemostasis
    was obtained. Port sites were injected with 0.5% Marcaine. We suctioned out
    the stomach with the EGD scope, desufflated the abdomen, and closed the
    fascial defect and 12 mm port with 0 PDS stitch. The skin incisions were
    reapproximated with 4-0 Monocryl stitches, cleansed and dressed with
    Dermabond. The patient tolerated the procedure well. She was extubated and
    returned to the recovery room in stable condition.

  4. Default
    I would use 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple).

    This code captures the EDG and biopsy of stomach. In the op report that you posted has no indication of gastrectomy, only endoscopic visualization and excision of the lesion.

    Hope this helps...
    Last edited by TonyaMichelle; 11-29-2011 at 09:24 AM.

  5. Default
    thank you so much!!

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