# Gastric Ca. with metastasis to Sister Mary Joseph Lymph Node @ Umbilicus



## deborahcook4040 (Nov 4, 2008)

I was hoping someone else has come across this one. My Surgeon removed the Gastric Adenocarcinoma and the lymph node. I have two problems. First, i'm not sure how to code the excision of the mass, as it extends all the way through the skin. Second, i'm not sure my Physician's dictation is detailed enough to support the amount of work he did. There's more relating to opening, closing, anastomosis, etc, but this is the only part that deals with the actual excision.

The relevant portion of the op report is as follows:

The antral mass was able to be mobilized; it was not fixed; it was not penetrating the wall posteriorly or anteriorly. The lesser omentum and the gastrocolic omentum were taken down with a LigaSure around the greater curvature, and dissection was carried out to disect the first portion of the duodenum that came up nicely. A pursestring suture device was placed on that and the duodenum amputated. A TA 90 stapler was used to transect the proximal stomach and passed off the table as a specimen marked.

Frozen section margins were good for the stomach. There was minor involvement of the skin at the umbilicus; it was excised widely; this was reexcised wider.


Help? Anyone?


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## cmartin (Nov 17, 2008)

It sounds like one of the partial distal gastrectomy codes - 43631, 43632, or 43633 - depending on the type of anastomosis/reconstruction he used.  The skin part would probably be 11606...
C.Martin CPC-GENSG


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