# Fibrin Plug for Enterocutaneous fistula



## Williealawishes (Jun 8, 2010)

Repair of enterocutaneous fistula was made with Fibrin Plug.....
44640 does not seem correct since it seems so involved with bowel mobilization.
46707 sounds perfect....if it was an anorectal but...it is enterocutaneous.

Any suggestions?

PROCEDURE PERFORMED:  Fibrin plugging of enterocutaneous fistula.

PREOPERATIVE DIAGNOSIS:  Enterocutaneous fistula.

POSTOPERATIVE DIAGNOSIS:  Enterocutaneous fistula.

HISTORY:  The patient is a pleasant 71-year-old gentleman with a long
history of enterocutaneous fistula which has failed to resolve with
conservative management.  He is taken to the operating room for a fibrin
plug.

DESCRIPTION:  After informed consent was obtained, the patient was taken to
the operating room and placed supine on the operating room table.  After
general anesthesia had been established, the patient's abdomen was then
prepped and draped in the standard surgical fashion.  The fistula was
identified.  The tract was curetted.  A probe was used to identify the
tract of the fistula itself.  We then obtained Surgisis anal fistula plug,
hydrated it, placed it within the tract without any undue difficulty.  I
then injected fibrin glue around this to help hold it in position.  The
skin overlying the patch was then reapproximate with 3-0 Monocryl suture.
Vaseline gauze as well as a light pressure dressing was then applied to
help provide for adequate pressure to hold the plug in place.  The patient
returned to the recovery room, extubated, and in stable condition.  The
patient tolerated the procedure well.  There were no complications.


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## Williealawishes (Jun 14, 2010)

I have decided to submit billing code 44640 with modifier 52 reduced service.  If anyone has any other suggestions I would love to hear them.  Thanks in advance.  Tracy


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## tmoses (Jun 28, 2011)

look at 46706


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## colorectal surgeon (Jun 30, 2011)

I like 44640. do you have to use the 52 is the question. it states closure but not how?


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