# Need help coding removal of Lap band, open



## sphillips56 (Sep 2, 2011)

I am new to coding and am having a hard time with this.  I can't find a code for open removal of Lap-Band with its tubing.  I used 49040 for drainage of abdominal ascites.  I would be very grateful of any advise...sharon
please send to sharon@secure.genvascsurg.com 
PROCEDURES:
1. Drain abdominal ascites.
2. Culture of abdominal abscess.
3. Expiantation of Lap-Band with its tubing.
FINDINGS:
There was an abscess cavitt. surrounding tho tubing of the Lap-Band, which was localed just below thc~
in the epigastrium. The Lap-Band was in good position and the band itself did not appea r to be infected.
DESCRIPTION OF PROCEDURE:
The patient WClS anesthetized, positioned, pr,epped and draped so as to expose the abdomen. An epigastric
incision was made from the xiphoid to the umbilicus and deepened through skin and subcutaneous tissue with
Bovie for hemostasis. There was a fair amount of subcutaneous edemCl. Supe riorly, the fascia was normal
and inferio rly the fascia was ma rkedly thickened, probably as a reaction to the underlying abscess . We divided
the thickened fascia and entered an <lbscess cavity. This was cultured , aerobic, anaerobic and in the midst of
this cavity was the remnants of the Lap-Sand tubing.
We extended the fascial incision superiorly and entered the abdomon.
A large amount of ascites was aspirated at this time. The !~ft lobe of tho liver was encountered and this was
not adhorent to surrounding structu res; however, tho undetrsUrfaca of the left lobe of the liver was adherent to

Operative Report
the lesser curvature of the stomach and the ante rior wall of the stomach. Appropriate relraction was obtained
and later in the opcr<ltion, we inserted a Gomez retractor, which afforded us excellent exposure of the
di<lphr<lgmatic hiatus and Ihe area ofthe l ap-Band.
We turned our allonlion to the tubing and using a combination of sharp and blunt dissection, we was able to
foHow this superiorly for several inches and then it appc<l red to bo intimately adherent to the liver and we
stopped our dissection at this point.
We were able to palpate the Lap-Band on the stomach near the gastroesophageal junction. We inserted a
Gomez retractor to elevate the xiphoid superiorly and the left lobe of the liver was retracted to the right and the
greater curvature of the stomach and the spleen were letracled to the left. This allowed us to visualize the
area of the Lap-Band. The lesser curvature of the stomach was dissected off of the undersurface of the liver
without entering the liver. We used a UgaSure device and Bovie for this. Eventually, we were able to visualize
the Lap-Band and using tho Bovie, we incised tho tissue over the lap-Band over a distance of approximately
an inch and a half. Wo were unable to identify the buckle in this area .
We elected to divide the Lap-Band and with traction, we were able to extract the Lap-Bnnd and its attached
tubing. The stomach was not entered during this maneuver and the liver was nol vio lated.
There did not appear to be infection around the lap-Band itself. With all of the foreign material removed, we
debrided of granulation tissue in the capsule in the abscess cavity perfected hemostasis with coagula tion
current.
A drain was placed in the depths of the wound exiling through an infe rior stab wound. We closed the fascia
after irrigating with dOllble antibiotic solution. We closed tho fascia with a running looped #1 PDS suture. We
irrig<lted the subcutaneous fat and closed the skin with staples and then drain was sutured to the skin with 0
silk and suction was applied.


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