# EGD with closure of esophagocutaneous fistula



## sandeepp (Sep 13, 2017)

Hi ,

Can anybody please advise CPT code for EGD with closure of esophagocutaneous fistula done endoscopically.


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## Ritika (Sep 13, 2017)

Hi Sandeep,

I think You should code it as 44799, the unlisted procedure for small intestine as there is no specific code for EGD with closure of esophagocutaneous fistula done endoscopically.


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## sequester25@gmail.com (Sep 13, 2017)

Can you provide a scrubbed portion of the operative note? what techniques did he use?


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## sandeepp (Sep 14, 2017)

*EGD with closure of esophagocutaneous fistula - Detailed description*



sandeepp said:


> Hi ,
> 
> Can anybody please advise CPT code for EGD with closure of esophagocutaneous fistula done endoscopically.



Hi,

With reference to query mentioned above, please find below detailed descripton of this procedure:

PROCEDURE: EGD with closure of esophagocutaneous fistula, stent placement under endoscopic and fluoroscopic guidance.

INDICATIONS:
Anastomotic leak after esophagectomy in a patient with history of esophageal cancer, status post chemoradiation prior to surgery.

PROCEDURE TECHNIQUE: The patient was intubated by general anesthesia. The Olympus GIF-190 forward-viewing video endoscope was lubricated and advanced into the hypopharynx. The scope was passed into the esophagus. The previously placed fully covered esophageal stent was seen. Distal to the end of the stent, the previously seen esophagocutaneous fistula was seen and appeared to be smaller in size. A new anastomotic leak was noted. I was able to pass the scope into the cavity where a percutaneous blue drain was seen. The esophagogastric junction was identified with difficulty. I was able to enter the scope into the stomach. The pylorus was identified. Endoscope was then advanced into the jejunum. A 0.035-inch Jag guidewire was advanced into the jejunum. Endoscope was then withdrawn all the way out. The double barrel endoscope was then used. An Apollo OverStitch device was attached to the tip of the scope. The scope was advanced back into the esophagus. The closure of the anastomotic leak was attempted. The tissue was friable. I had to use a biopsy forceps to pull the stomach into the suturing device. The edges of the leak was approximated. At this point, fibrin glue and amino acid solution were injected around the anastomotic leak area. A paper clip was placed on the patient's chest to identify the area of the anastomotic leak where an esophageal stent will be placed above it. A 15-cm in length x 23 mm in diameter fully covered esophageal stent was then deployed under fluoroscopic guidance. A short stent measuring 12 centimeters in length x 23 mm in diameter was placed above the first stent. The OverStitch device was placed back on the double channel upper endoscope and the scope was advanced back into proximal esophagus. The proximal end of the proximal fully covered the esophageal stent was identified and the stent was then sutured to the esophageal mucosa.


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## sequester25@gmail.com (Sep 14, 2017)

wow! this one got me too.

43499 - unlisted procedure for esophagus
    (compare to) 43360 - Gastrointestinal reconstruction for previous esophagectomy, for obstructing esophageal lesion or fistula, or for previous esophageal exclusion; with stomach, with or without pyloroplasty
             or        43420 - Closure of esophagostomy or fistula; cervical approach

43266 - for stent placement - he did go into the "stomach" and jejunum but you could also look at 43212 for esophagus only

dont forget about the fluoroscopic portion and the Hcpcs (i could not find one myself) 

maybe someone with more experience can modify or expand this


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