# Fasciotomy and revision of gastroschisis silo



## latonya78 (Nov 19, 2013)

need help with CPT code for a gastrochisis silo revision. My thought is that the service is not billable and is considered part of the global. Any thoughts? See note below.

PREOPERATIVE DIAGNOSIS: Gastroschisis with ischemic intestine, silo, planned return to the OR for revision of silo.

POSTOPERATIVE DIAGNOSIS: Gastroschisis with ischemic intestine, silo, planned return to the OR for revision of silo.

PROCEDURE: Fasciotomy and revision of gastroschisis silo.

INDICATIONS AND FINDINGS: This is a baby with a prenatal diagnosis of gastroschisis, had an ischemic event after birth, had dusky bowel when we placed a silo on last night, but appeared to be reasonably viable, although very sustained from meconium and amniotic peritonitis. Through the night it had gotten darker and darker so this morning we, in an effort to give him every benefit of the doubt, we revised the silo. We removed the old one and placed a much bigger one, 6 cm ring under the fascia and extended the opening of the gastroschisis defect cephalad for 2 to 3 cm to make a good wide opening. It was already quite wide. The abdomen was already quite soft and the bag already quite loose, but we just made it even more so to give him every benefit other doubt. The bowel was quite ischemic. The family was informed of the very poor prognosis situation given the ischemia. It was a little bit pinker at the base in the more proximal small bowel and distal colon, but the apex of the midgut was still quite ischemic. There was no twist of the mesentery. No kinking or tension at the fascial level at all.


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## Cynthia Hughes (Nov 19, 2013)

The indications and findings show that the physician planned and created a larger opening in the fascia and created a larger opening for the silo. It sounds like a separately reportable revision procedure to me. Would need modifier 58 (eg, 49605-58) to indicate that this is a planned return and more extensive procedure than the first.


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## latonya78 (Nov 19, 2013)

Thanks for your help.


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