# Expl Lap, Biopsy of perf ulcer, omental patch CPT



## bill2doc (Oct 4, 2012)

Could someone offer some CPT help please....  I get 43840 and possibly 49905 but where does the biopsy come in?? Thank you so much !

UPPER MIDLINE INCISION MADE AND CARRIED THROUGH SUBCUTANEOUS FAT AND FASCIA. ABDOMEN ENTERED. SIGNIFICANT AMOUNT OF GREEN MURKY FLUID WAS EVACUATED AND IMMEDIATELY RETURNED.  STOMACH WAS IDENTIFIED AND DRACED TO THE DUODENUM. THERE WAS A LARGE MASS WITH OMENTAL ADHESIONS AND SMALL DRAINING HOLE.  TISSUE AREOUND HOLE WAS FRIABLE AND APPEARED TO NOT BE THE ULCER BUT AN INFLAMMATORY RING AROUND THE ULCER. THE OMENTUM WAS DISSECTED AWAY DUODENUM WAS EXPOSED. ULCER WAS NOTED TO BE QUITE LARGE AND WAS WITHER THE PYLORIC CHANNEL OR PROXIMAL ASPECT OF THE DUODENUM. THE PYLORUS WAS HARED TO IDENTIFY GIVEN THE SURROUNDING INFLAMMATION. GIVEN THE SIZE, SEVERAL SHAVE BIOPSIES WERE TAKEN AND SENT OFF THE FIELD AS SPECIMEN. AN NG TUBE WAS ADVANCED AND BROUGHT OUT THROUGH THE ULCER AND MANUALLY ADVANCED PAST THE ULCER. THE ULCER WAS THEN CLOSED IN A CONTINUOUS FASHION THROUGH THE THICKENED TISSUE AND THE EXPOSED MUCOSA. SILKS WERE PLACED ON EITHER SIDE OF THE ULCERATION  AND A FLAP OF OMENTUM BROUGHT DOWN AND LIAD ACROSS ULCER AND SECURED IN PLACE.

ABDOMEN FURTHER EXPLORED. SMALL BOWEL TRACED FROM LIGAMENT OF TREITZ TO THE ILEOCECAL JUNCTION AND NO OTHER LESIONS NOTED. ABDOMEN IRRIGATED AND CLOSED

SORRY FOR ANY TYPO'S !!!


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## bill2doc (Oct 11, 2012)

Now getting 49040 and 44005....confused.... ??????


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## syllingk (Oct 12, 2012)

I like your first choice.
43840 and 49905.
I am thinking the biospy is going to be included in the larger procedure.


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