# Removal of foreign body



## RFoster1 (Aug 21, 2013)

Any suggestions appreciated.

Operative Procedure:
After informed consent was obtained from the parents, the patient was brought to the operating room, placed supine on the operating table.  A shoulder roll was placed behind her shoulder blades.  General anesthesia was administered by the anesthesia team.  Flexible endoscope was advanced into the esophagus and the battery was visualized within the proximal esophagus. Although there was some mucosal inflammation present, there was no evidence of necrosis.  However, the mucosa appeared to encroach upon the battery making it difficult to manipulate.  Multiple endoscopic graspers were used to try and retrieve the battery.  Next, a Foley catheter was passed beyond the battery.  The Foley balloon was insufflated with contrast under fluoroscopic guidance.  Then, we attempted to remove the battery with a combination of retraction on the Foley as well as a grasping with the endoscopic graspers.  Although we were able to remove the battery proximally, we were not able to completely retrieve it.  Next, we performed a rigid endoscopy and used multiple graspers passed through the rigid esophagoscope.  Again, we used a combination of the Foley balloon as well as the graspers to attempt retrieval.  We were simply not able to maintain the grasp on the battery to retrieve it.  However, during these manipulations, we were able to push the battery further into the esophagus.  Thus, we decided to repeat the flexible endoscopy and attempt to push the battery into the stomach.  After several attempts with the flexible endoscope the battery was ultimately advanced into the stomach.  A basket was then passed through the flexible endoscope and the battery was grasped by the basket.  The endoscopic basket and endoscope were then removed which did require some pressure at the level of the proximal esophagus.  Intraoperative fluoroscopy demonstrated no evidence of esophageal perforation with no pneumomediastinum or pneumothorax.  

Physician turned in 43215 but I don't feel that completely covers the extent of work performed.  Looking at 43247 but neither the duodenum or the jejunum were involved.


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## FTessaBartels (Sep 12, 2013)

*43215 (m22)*

I would use 43215 with a -22 modifier, and increase my fee by about 25%.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## hbeard (Sep 13, 2013)

You are correct, 43247 would not apply since he did not pass the pylorus. 43215 with a -22 for increased difficulty would be appropriate (encourage the provider to document the extra time spent with difficult cases like these.) Don't forget about 76000 since the provider used the fluoro images to help with this case (unless a radiologist was the one who interpretered them)


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## RFoster1 (Sep 16, 2013)

Thank you both!


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