# Partial Gastrectomy assistance?



## ksb0211 (Apr 29, 2011)

Okay, so this is the situation....One of our surgeon's performed a surgery, his partner performed the EGD.  How exactly should I code this out (for each doctor)?  

PRE & POSTOPERATIVE DIAGNOSIS
GIST tumor of stomach x 2.

PROCEDURE/OPERATION
Exploratory laparotomy, partial gastrectomy, esophagogastroduodenoscopy by Dr. XXX

SURGEON
Dr. YYYYYY

DESCRIPTION OF PROCEDURE
The patient was taken to the operating room and after induction of adequate general anesthesia, the patient was prepped with DuraPrep and draped sterilely. Perioperative antibiotics had been administered.
The initial incision was made in the epigastrium in the midline. The incision was carried down through the subcutaneous tissues.
The peritoneal cavity was entered. The Bookwalter retractor was placed. It was immediately evident where the larger tumor was to be found, it was at the greater curvature, approximately mid stomach. This had previously been biopsied laparoscopically, by entering through the omentum into the lesser sac. The omentum was taken down along the greater curvature. The area was well exposed. The tumor itself was clearly at the greater curvature. Attempt was then made to find the second tumor, which Dr. Patel had identified, which was in the antrum. I was unable to palpate the lesion. The Satinsky clamp was then put across the distal stomach at the level of the pylorus and the upper GI endoscope was passed by Dr. XXXXX. We were not able to see the lesion well with this, and the clamp was then moved to the proximal jejunum, past the ligament of Treitz. The lesion was noted to be submucosal mass, approximately 4 cm proximal to the pylorus. A stitch was placed to help mark the area. Once this was completed, the larger lesion was addressed by passing the TA-90 across the greater curvature in attempt to allow for adequate margin. The TA-90 was fired and the lesion was excised. The lesion at the proximal end of the stomach was very close to our suture line. A TA-60 stapler was then placed again and additional stomach was taken. The suture line was then reinforced with interrupted 3-0 silk suture. With good hemostasis achieved, attention was turned to the more distal lesion. The lesser omentum was taken down to allow circumferential excess to the distal stomach. The serosa was incised and the stomach entered. We were able to see and feel the lesion that was into the gastric wall. The Allis clamp was applied and this was then excised. It was actually a fairly well encapsulated lesion. It was passed off as specimen. Once this was done, decision was to close this enterotomy with staples.
The incision had been made longitudinally. It was then closed transversely in the fashion that we would do a pyloroplasty. Stay sutures of silk were placed. The TA-60 was applied with green staples. Good hemostasis was achieved, then the suture line was reinforced with interrupted 3-0 silk suture. Omentum was tacked down with it. A 10-mm Jackson-Pratt drain was placed. Estimated blood loss was perhaps 200 mL. Nasogastric tube placement was reaffirmed. No other pathology was noted.
The midline incision was closed with running double-stranded #1 PDS sutures. Clips were applied to the skin. Dry sterile dressing was applied.  The patient tolerated the procedure well.


UGH!  Thansk for any help or thoughts.....


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## surgonc87 (Apr 29, 2011)

6. A “scout” endoscopy to assess anatomic landmarks or assess extent of disease preceding another surgical procedure at the same patient encounter is not separately reportable. However, an endoscopic procedure for diagnostic purposes to decide whether a more extensive open procedure needs to be performed is separately reportable. In the latter situation, modifier 58 may be utilized to indicate that the diagnostic endoscopy and more extensive open procedure were stage procedures

Straight from the NCCI

So the most the other doc can do is a minimal assist or a regular assist to the primary reporting CPT.

Hope that helps

MS


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