# EGD - ? discontinued procedure



## lindacoder (Nov 21, 2011)

With the patient in the left lateral decubitus position, the esopahgeal gastroscope was introduced into the oropharynx. This was advanced down to the proximal esophagus without difficulty. Upon reaching the GE junction, a large amount of food in the bezoar is present and a very large hiatus hernia. Almost 30 minutes wa spent trying to wash this all off so we could visualize the mucosa of the hiatus hernia. This was not possible to completely get rid of this bezoar. The patient did actually spit up large chunks of indigested food during this time. This was made up of wild rice and other particulate matter which she had probably eaten in the last few days. The scope was retroflexed and a partial view of the GE  junction was obtained. The bezoar still included part of this and I was unable to wash it off in spite of multiple attempts. The distal esophagus appeared normal all the way to the GE juntion, but again particulate matter prevented full visualization of this area. The scope was retroflexed and inside the hiatus hernia and again a good portion of the retroflexed part of the hiatus hernia was not able to be visualized in spite of multiple attempts at irrigation and dislodging the bezoar with the scope. Attention was then turned towards the body of the stomach. This appeared normal although there were flecks of undigested food throughout it. There were no ulcers in the first portion, second portion, third portion and fourth portion. The duodenums were all cannulated and these appeared to be normal. The scope was then withdrawn back into the stomach and further attempts at visualizing the hiatus hernia which was filled with undigested food were attempted. These were unsuccessful.  The scope was then withdrawn back into the esophagus and the remainder of the esophagus appeared normal.

IMPRESSION: Very large hiatus hernia with possibly some degree of gastric motility difficulty. Undigestedfood bezoar in the hiatus hernia. Underlying abnormality of the gastric mucosa cannot be excluded.

PLAN: Place the patient on a clear liquid diet for 3 days and repeat endoscopy. We may also obtain and upper GI on the patient. 

Looking at 43247 with 53 modifier - any suggestions??

Thanks


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## syllingk (Nov 21, 2011)

That doesnt sound like a d/c procedure to me. Says that the duodenum was intubated. That is the whole scope top to bottom. Just a visualization problem at the hiatal hernia site because of the phytobezoar (935.2).


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## GaPeach77 (Nov 21, 2011)

From the report it appears to be more of a reduced service (52) opposed to a dc procedure.


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