# Gastrostomy tube & Ostomy bag?



## chembree (Aug 7, 2013)

Can anyone offer any advice about how I should code this procedure? I am not sure how or if I should code the Ostomy bag. This seems like more than just a simple gastrostomy tube placement code. Thanks in advance for the help. 


PROCEDURE: Fluoro-guided percutaneous gastrostomy tube placement:

HISTORY:  Need for new gastrostomy site. Long-standing previous
gastrostomy site problematic in terms of continued leakage.

Informed written consent was obtained after discussing the procedure,
risks, benefits, alternatives with the patient and family. Moderate
sedation with physiologic monitoring is administered by radiology
nurse under my supervision with adequate pain control. Patient
received Versed IV, fentanyl IV. Sedation time is 45 minutes.

The patient is placed in the supine position on special procedures
table. The stomach is distended with air by injecting through existing
gastrostomy tube before removal. Using fluoroscopic guidance, stoma
tract insertion site is selected in the left lateral subxiphoid
region, being careful to avoid bowel, liver, and other structures. The
site is prepped and draped with ChloraPrep. Equi-distant from the
selected insertion site, 3 gastropexy anchor insertion sites are
chosen. The skin and deep soft tissues are infiltrated with 1%
lidocaine. Kimberly Clark MIC G introducer kit is used. Using
fluoroscopic guidance, each of the 3 slotted suture anchor needles is
advanced into the gastric lumen through the anterior wall. Each T- bar
anchor suture is deployed and pulled against the anterior wall. Each
suture lock is clamped in place. The safety introducer needle is then
advanced through the stoma tract site through the anterior gastric
wall into the lumen as confirmed by fluoroscopy. The J guidewire is
advanced through the needle into the stomach. The safety introducer
needle is removed. Small skin incision is made with #11 scalpel at
this site. The serial dilator is advanced over the guidewire and
serial dilation of the stoma tract is performed. The peel-away sheath
is advanced into the gastric lumen. A Kimberly Clark MIC 18 French
gastrostomy feeding tube is advanced through the peel-away sheath into
the gastric lumen as confirmed by fluoroscopy. The retention balloon
is inflated with 10 mL sterile saline admixed with nonionic contrast
and pulled against the anterior gastric wall. Retention hub is
advanced down to the skin level. Contrast is injected through the
gastrostomy tube to confirm position in the stomach and to exclude
extravasation. There is no evidence of extravasation or significant
free air. Bandage was applied at the insertion site. The patient
tolerated the procedure well and left the interventional suite in
hemodynamically stable condition.

IMPRESSION: Successful Fluoro-guided placement of new percutaneous
gastrostomy tube.  Previous gastrostomy site abandoned.  Ostomy bag
was placed over the site.


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