# Code for ligation of duct of Luschka



## Mklaubauf (Oct 10, 2012)

Hi,
Never had this, we had to go back in after a laparoscopic cholecystectomy to due to drainage of biloma.

The physician had to ligate the duct of Luschka.

My Dr. said no to code 47900.    

I'm looking at 47400.    help.
Thank you.
Marci


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## hewitt (Oct 10, 2012)

Not enough detail.... Can you copy and paste the note detail for the ligation?


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## Mklaubauf (Oct 10, 2012)

Here is the procedure note:
Procedure:  Exploratory laparotomy with drainage of biloma and ligation of duct of Luschka.
Postoperative Diagnosis:  Postoperative bile leak.

After satisfactoy induction of anesthesia, the anterior abdominal wall was prepared with an antiseptic and draped with sterile drapes.   The previous dressings had been removed. A right upper quadrant incision was made and carried down through the subcutaneous tissue.  Superficial vessels were  electrocoagulated.   The external oblique fascia was sharply incised.  The rectus muscle was divided with electrocautery.   The epigastric artery and vein wereligated with 2-0 chromic or 2-0 silk.  The posterior rectus fascia and peritoneum were entered withcare to avoid the intraabominal contents.   Immedidately upon entering the peritoneum, bilious fluidwas present.  This was evacuated after culturing.  The colon and small bowel were packed inferiorly, exposing the right upper quadrant.  The cystic artery stump was identified with a clip.  In addition, the area of the Endoloop securing the cystic duct was also identified and was dry.   Upon exploration of the gallbladder bed, however, in the more medial gallbladder bed, a small duct was identified as leaking.  This was controlled with 2-0 chromic.  The remainder of the bed was unremarkable.  The entire area was carefully inspected and observed for several minutes.  No further leaking could be identified.  The abdomen was irrigated with fluid and we evacuated as much bile out of the abdomen as possible, including the pelvis and left upper quadrant.  In addition, the suprahepatic spaces were also evacuated and irrigated.  Two Blake drains were brought in through separate stab wounds with care to avoid the intraabdominal contents and placed in the subhepatic space.  In addition, the omentum was carefully place within the subhepatic space.  Firm stool was noted within the transverse colon.   All packs and instruments were removed.  Counts were correct.
The drains were secured to the skin with 3-0 silk.  The incision was closed in 2 layers and initial layer of running 0 Vicryl beginning at each end of the incision and meeting in the middle.  The wound was again irrigated with saline and infiltrated with 0.5% plain Marcaine.  The anterior rectus fascia, internal and external oblique fascias were closed with running 0 loop nylon beginning at each end of the incision and meeting in the middle, burying the knot.  The skin was also infiltrated with 0.5%plain Marcaine, and the skin was closed with wide stainless steel skin staples.   Dressings were applied.  The patient  tolerated the procedure well.


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## hewitt (Oct 10, 2012)

Thank you! Unfortunately, the only code I see that best applies is the unlisted code 47999. I see nothing specific enough that allows coding that kind of duct.


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## Mklaubauf (Oct 11, 2012)

Thank you for your time with this.   For this unlisted procedure, what code would you advis that it would be equal to?  
Again, thank you for your time.


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## hewitt (Oct 11, 2012)

I do not know how to determine the value.    You will have to send the operative note with the claim.


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