# Gastrojejunostomy,cholecystojejunostomy,umbhernia, lysis of adhesions



## Hopp (Apr 2, 2008)

How would the following be coded?   Pt.was supine & placed under gen.anest.  Abd was scrubbed & prepped.  An upper midline incision was extended thru the skin and Subcutaneous tissue taken down to the midline fascia,which was incised.  The peritoneum was identified,incised and the abd was entered.  Incision was extended from the xiphoid down to several cm below the umbilicus to incorporate a small umbhernia in this area.  The gastrocolic ligament was divided exposing the undersurface of the stomach.  A loop of proximal jejunum was then brought up and a sidetoside anastomosis was then done to the gallbladder using the GIA as well.  Prior to the anastomosis a gb stone was removed.  Insertion holes were also closed with the TA-60.  The anastomosis was also reinforced using interrupted 4-0 silk,  The lumens following completion of this anastomosis were satisfactory.  The mesenteric defect here was closed using 2-0 dexon.  Following this the abd. was irrigated with Ancef solution, all of which was aspirated.  A 10 mm Snyder drain was placed through a stab wound in the rt. abdomen.   This was secured to the skin using 30 wire and placed in the region of the cholecystojejunostomy anastomosis.  The midline fascia was then closed using #1 Maxon suture.  The wound was sprinkled with Ancef powder and the skin was closed with skin staples, covered with antibiotic ointment and a sterile compression dressing.       (47721 & unlisted procedure code 447799)  Thanks


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## cmartin (Apr 11, 2008)

From the description, I'm only getting 47720 - anast of jejunum to gallbladder.  Since it mentions a loop, possibly they did a Roux-y, but I think they need to re-dictate if they did anything beyond 47720.
Connie Martin CPC-GENSG


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