# REDO Lap take down Dor fundoplication



## Coder708 (May 7, 2010)

Not sure if I should go for the Unlisted code 43289

Patient had Laparoscopic Heller myotomy w Dor fundoplication---
3 days later had REDO w takedown.. See Op note below


The Olympus flexible esophagoscope was
inserted into the oropharynx and through the cricopharyngeus muscle which
was at 15 cm from the incisors. There was some murky fluid within the
esophagus, which was felt to be salivary secretions. The GE junction was
at approximately 40 cm from the incisors and it did look flattened out.
The scope was pulled back to the mid esophagus and left in place, and the
patient's abdomen was prepped and draped in the usual sterile fashion.
The prior incisions were used and the Hassan technique was again utilized
to place the first port in the right upper quadrant. The remainder of the
ports placed where exactly the same as the previous case done on
04/16/2010. The liver retractor was placed in the left lateral segment of
the liver and secured to the static arm. Using graspers, the stitches
holding the Dorr fundoplication in place were cut and gentle blunt
dissection was used to tease the Dorr fundoplication off the myotomy.
There was a significant amount of inflammatory change. Esophagoscopy was
then performed and it was noted that it lost the flattened appearance
that was seen prior to taking down the Dorr fundoplication. The length of
the myotomy was re-examined and it was felt to be adequate. There was no
bleeding. Saline was placed into the upper abdomen and insufflation was
performed through the esophagoscope to ensure that there was no leak. The
scope was withdrawn, fluid aspirated out of the abdomen and the liver
retractor was removed under direct vision. There was no bleeding from the
port sites and they were all removed. The fascia was closed at the Hassan
port site with a 2-0 Vicryl suture and then 4-0 Vicryl was used to close
the skin at the other port sites. Band-Aids were applied to the sites.
The patient was taken in stable condition to the recovery room. All
needle, instrument, and sponge counts were correct at the end of the case
x2. There was no blood loss.


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## ballekll (Sep 28, 2010)

*response to take down fundoplication*

On 3M, I was coding take down of fundoplication and unfortunately, it also took me to an unlisted, 43999. Unlisted procedure, stomach.The software did not differentiate between open and laparoscopic takedown so it would seem that 43659 or 43289 would be fine if you were taking it down laparoscopically as that would be a more specific unlisted code by approach.


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