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Open Removal of Gastric Restrictive Device and Port Components

  1. #1
    Red face Open Removal of Gastric Restrictive Device and Port Components
    Medical Coding Books
    Our provider is billing the following codes: 43774; 49585; and 49000.
    I know that 49000 will bundle, but I cannot find a code for Open removal of the device and components. The closest found was 43887 which addresses the port only. I even considered 43500 (Gastrotomy; with exploration or foreign body removal), since 43774 - 52 is out of the question. Please help. The available guidelines and rationale doesn't seem to cover this scenario.

    1. Exploratory laparotomy.
    2. Biopsy of peritoneal implants in the omentum.
    3. Removal of lap band and subcutaneous port.

    ANESTHESIA: General endotracheal anesthesia.

    INDICATIONS: This is a 57-year-old female who presented with a signet ring cell carcinoma of the stomach in 06/2011. She underwent induction chemotherapy with a good response and is now scheduled for definitive resection.

    She additionally had a lap band placed approximately 1 year ago and is desirous of having this removed.

    DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and after adequate general endotracheal anesthesia, the patient's abdomen was prepped and draped in a sterile fashion. The abdomen was opened through an upper midline incision and manually explored. _____ peritoneal implants were identified; several in the porta and 1 on the anterior abdominal wall and some in the pelvis. Several of these were biopsied and sent for frozen section and were found to be consistent with metastatic adenocarcinoma.

    I identified the catheter from the lap band and freed up from the adjacent omentum. I incised the pocket in the left upper quadrant and dissected down around the lap band port. The port was completely removed from the pocket and the catheter was cut. The catheter was then removed intraabdominally, and then I disentangled the lap band device itself from the proximal stomach and removed the entire device and sent it to pathology for gross only identification.

    The patient had no clinical evidence of obstruction or bleeding and I did not feel that a palliative resection was indicated. So, I elected to terminate the operation. The abdomen was then irrigated with normal saline and after ensuring hemostasis I then prepared for closure.

    There was an umbilical hernia that was identified at exploration and I repaired this with a figure-of-eight #2 Vicryl suture.

    Next, the incision was closed with a running #2 Vicryl suture. The subcutaneous tissues were irrigated with normal saline and the skin was closed with skin staples.

    Next, the port pocket in the left upper quadrant was closed with interrupted 3-0 Vicryl deep fatty sutures followed by skin staples. Dressings were applied. The patient was awakened, extubated and taken to the recovery room in stable condition. Time of procedure was 1 hour and a half.

  2. Default lap band and port removal
    The CPT code 43774 states complete removal of lap band, port and all it's components.

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