# Laparoscopic Nissen fundoplication and Gastrostomy tube



## latonya78 (Apr 5, 2015)

Laparoscopic Nissen fundoplication and Gastrostomy Tube
The following procedure was coded as 43280 but when audited by an departmental auditor, the auditor suggested adding cpt code 43246.

I do not agree with coding CPT code 43246, but I do not have any supporting documentation to support why I would not add 43246.

It does not appear based on the documentation that the GT placement was done endoscopically as described by cpt code 43246.

Any feedback is appreciated.




OPERATION: Laparoscopic Nissen fundoplication and Gastrostomy Tube


ANESTHESIA: General endotracheal anesthesia.

ESTIMATED BLOOD LOSS: Minimal.

DRAINS: 12F, 1.0 mic-key


SPECIMEN REMOVED:

COMPLICATIONS: None.

INDICATIONS FOR PROCEDURE: The patient is a 6 W with the above findings. Informed consent for the above procedure was obtained from the patient's parents.

FINDINGS: Normal intraabdominal anatomy.

TECHNIQUE: The patient was brought to the operating room and placed in a supine position. General anesthesia was induced. The abdomen was prepped with iodoform and draped. All trocar sites were infiltrated with lidocaine 0.25% with epinephrine 1:400,000. A small vertical stab wound was made in the umbilicus and a 3.5-mm trocar was then placed. Four 3.5-mm trocars were placed in the abdomen. The liver retractor was placed through a stab wound. The liver was retracted superiorly and dissected was begun of the esophagohepatic ligament which was divided with Bovie electrocautery and the dissection was taken across the anterior aspect of the esophageal hiatus. The superior short gastric vessels were then divided with hook Bovie electrocautery. The esophageal hiatus was not mobilized. The fundus was brought through the retroesophageal window and a fundoplication was performed, wrapped with the vagus nerves on the inside. Both the anterior and posterior vagus nerves were identified and carefully preserved. The fundoplication was then performed over a 14F suction catheter by taking sutures from the fundus to the esophagus to the wrapped fundus. Two of these sutures were taken, followed by a third between these two from stomach to stomach for reinforcement. The fundoplication was inspected and noted to be sufficiently floppy.




Anesthesia then placed a tube into the stomach and the stomach was inflated with air. The anterior wall of the stomach, between the greater and lesser curvatures, at the junction between the body and the anterior of the stomach, was brought up to the abdominal wall at the stab incision. Three T-fasiners were placed through the abdominal wall and into the stomach. Then, using Seldinger technique, a 1.0-cm #12 French MIC-Key button was placed in the stomach. The buttons were secured down to the skin.




The trocars were removed. The umbilical 3.5mm trocar sites were closed with interrupted 3-0 PDS suture and the skin at all the sites was closed with Dermabond. The patient tolerated the procedure well without any complications.


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## cynthiabrown (Apr 6, 2015)

I agree with you


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