# gastrojejunostomy stricture question



## DebbiePottsEngland

My question is regarding CPT billing and Icd-9 as well.  My situation is as follows.  On a gastric bypass patient, who is 3 years out from her bypass surgery returns to OR for an EGD, the physician performs the EGD and dilates the anastomosic site from the bypass.  THis is done through the scope.  I did not bill it with CPT 43245 as it says Gastric Outlet obstrustion as this is an anastomosis.  I also billed with ICD-9 code for complication of surgery diagnsis 997.1.  The doctor says this is the patients gastric outlet therefore, the 43245 and the 537.0 should have been billed.  that since the patient is three years out from her surgery it can not be considered a complication of the surgery.
I need some imput and if anyone has anything written in black and white as back up I would appreciate that as well.  
If I am wrong I will gladly resubmit a corrected claim.

Thanks


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## mikereyland

Well I hate to tell you...but I think your Dr. is right.  I see this a lot, 3 years out I would not consider that to be a complication from the Sx, although Gastric Outlet Obstruction is quite common in bypass patients.  I would code it as: 
43245 – 537.0, V45.86

Michael D. Reyland, CPC, CIRCC
Surgical Specialists of Georgia
Gainesville, GA


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## acf7575

*esophagogastroduodenoscopy with dilation anastomotic stricture*

I question the use of the 43245 as this is not a patient with normal anatomy and is not in the "bariatric surgery" section.  

Our patient had suspected anastomotic performation six weeks out and a diagnostic laparopscopy was performed finding only fat adhesed to the anastomosis that was gently dissected.  Next he did an esophagogastroduodenoscopy and Savory dilation of the anastomosis beginning with 18-French, then up to 21- French, 24-French, 27-French 30-french and finally 33-French with no evidence of leak.  

Since the patient is still in global to the original Lap Roux-en-Y gastric bypass, we are conserned with using a code that is not "bariatric" related as this could be misleading to the INS that is it not bariatric complication.  We have considered the use of unlisted code 43659 (of course this is laparoscopic, but there is no unlisted endoscopic code) and this is a "revision" of the prior gastric restrictive procedure which if it were an open procure would be 43848 for i.e. non-empting gastric pouch.  So for revisions we generally use the 43659 (Laparscopic).  

I am looking for professional bariatric advise regarding some of the revision procedures, i.e. my case above and if it is okay to use the 43245 even though it is not a "bariatric" code.  

Thanks,


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## Torilinne

*Gastric Outlet Obstruction*

My opinion would be to agree with the original physician's take on this. Although the patient had a gastric bypass, the surgery simply lessened the amount of "gastric" available for digestion. The physician re-approximated the jejunum to a different spot on the stomach but this is still the outlet.  43235 is the correct code. Use of the V45.86, included with the outlet obstruction code, will give the insurance company the full story.  There is no need to try to find a code from the Bariatric section as it's three years out and this is now the patient's "normal" anatomy. 

Torilinne
CPC, CGIC


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## acf7575

Okay, but what about i my case that is only 6 weeks status post.  What determines a timeframe of when it would not be a complication of the prior bariatirc surgery.  Had they not had that procedure, they would not be having this stricture.  The 43848 covers most complications, except that it is an open code.


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