# Any ideas on CPt codes for this procedure?



## jdibble (Jan 19, 2017)

PREOPERATIVE DIAGNOSIS:  Recurrent gastric volvulus and hiatal hernia.

POSTOPERATIVE DIAGNOSES:
1.  Recurrent gastric volvulus and hiatal hernia.
2.  Serosal tear.

PROCEDURE:  Exploratory laparotomy reduction of gastric volvulus and hernia and
gastropexy and gastric ligation.


FINDINGS:  Stomach partially volvulized up into the chest.  It was reduced and pexied in 2 areas.

INDICATION:  The patient had undergone reduction of a gastric volvulus and a gastropexy about 1-1/2 years ago.  She came in with hematemesis and was found to have a recurrent volvulus.  However, on EGD, an area of bleeding was not identified.  It was discussed with the patient and the family the need for recurrent surgery and reduction and that laparoscopic
approach may not be best for her or amenable.  They understood the possible risks, benefits, and complications of an open procedure and agreed to proceed with surgery.

DESCRIPTION OF PROCEDURE:  The patient was brought to the OR on 01/13/2017 and
placed supine on the operating room table.  After adequate general anesthesia, she was prepped and draped in a sterile fashion after a Foley had been placed. Then an upper midline incision was made and carried down to the subcutaneous tissue and the fascia.  The fascia and the peritoneal cavity was entered and the stomach was found to be flipped and up into the chest.  The previous pexy was still mostly intact.  The stomach was reduced out of the chest until the gastroesophageal junction was at least palpable, and the duodenum was placed in
its normal position in the stomach.  The previous gastropexy was then taken down.  During the stomach being held with a Babcock, and serosal tear occurred and this was repaired with a 3-0 silk Lembert stitch.  Once the serosa was repaired, the 0 Prolene was taken and attached to the anterior abdominal wall in the left upper quadrant and then to the stomach around this area with 2 stitches and sewn in place.  Then, the distal to this area in the stomach was stretched
down and then in the left mid quadrant, two 0 Prolene stitches were used to again attach the stomach up to the abdominal wall.  The NG tube was then felt for positioning and pulled back and straightened out.  Inspection was undertaken.  Other than that, no other abnormalities were noted.  The fascia was then closed in the midline with a running #1 PDS loop stitch and then the knot was buried.  Irrigation was undertaken in the subcutaneous tissue.  The skin was approximated with staples.  Before closing the skin, 05% Marcaine with epinephrine was injected around the incision site.  Then, the Opsite was placed on the incision.  The patient tolerated the procedure well, was extubated in the OR, and taken to the recovery room in stable condition.  All counts correct at the end of the case.


I cannot find any codes to use unless I use 43999. However I would need to supply a comparative code so that the billing could set a fee. So if anyone can tell me what CPT code to bill or if none, to compare with!

Thanks,


----------



## cgaston (Jan 20, 2017)

What about 43336?

Here is the description of the procedure from Procedural Reference Guide for Coders:

When the patient is appropriately prepped and anesthetized, the provider makes an incision in the abdomen and chest. He then visualizes the hiatus (the opening in the diaphragm where the esophagus passes through). He removes any adhesions. The provider then accesses the part of the stomach that has moved into the chest. He separates the stomach from the hernia sac. He ensures the stomach is in the cavity of the abdomen, moving it as needed. The provider may pass a bougie into the GE junction to dilate the passage. He also may use sutures to narrow the enlarged diaphragmatic esophageal hiatus. He then performs fundoplication by attaching the upper portion of the body of the stomach (or fundus) over the uppermost part of the GE junction with sutures. The provider removes the bougie (if present) controls any bleeding and closes the laparotomy incision.


----------



## jdibble (Jan 20, 2017)

cgaston said:


> What about 43336?
> 
> Here is the description of the procedure from Procedural Reference Guide for Coders:
> 
> When the patient is appropriately prepped and anesthetized, the provider makes an incision in the abdomen and chest. He then visualizes the hiatus (the opening in the diaphragm where the esophagus passes through). He removes any adhesions. The provider then accesses the part of the stomach that has moved into the chest. He separates the stomach from the hernia sac. He ensures the stomach is in the cavity of the abdomen, moving it as needed. The provider may pass a bougie into the GE junction to dilate the passage. He also may use sutures to narrow the enlarged diaphragmatic esophageal hiatus. He then performs fundoplication by attaching the upper portion of the body of the stomach (or fundus) over the uppermost part of the GE junction with sutures. The provider removes the bougie (if present) controls any bleeding and closes the laparotomy incision.



Thanks for pointing me in the right direction! I think I will go with code 43332 however because the incision was midline and not thoracoabdominal.


----------

