# Laparoscopic plication of hemidiaphragm



## pkoens (Nov 6, 2015)

I am trying to find a CPT code for a laparoscopic plication of hemidiaphragm.  I find 39545 for open  imbrication but  not sure if I should be looking at unlisted code for laparoscopic approach.  Much of the information I am finding points me to hernia repair section.  Any help will be greatly appreciated.


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## manib84@yahoo.com (Nov 11, 2015)

Can you post the op note?


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## Daisymm (May 20, 2022)

Hello I too am seeking assistance with coding the below op note, for Robotic/laparoscopic Diaphragmatic Plication - all my searching is pointing toward 39545, and or using an unlisted 39599. I would appreciate any guidance.  THANKS

PREOPERATIVE DIAGNOSIS: SHORTNESS OF BREATH WITH PARALYSED RIGHT HEMIDIAPHRAGM.
POSTOPERATIVE DIAGNOSIS: SHORTNESS OF BREATH WITH PARALYSED RIGHT HEMIDIAPHRAGM.
OPERATION: ROBOTIC DIAPHRAGMATIC PLICATION.

INDICATIONS: This is a patient who presented with paralyzed right hemi diaphragm. His entire liver had herniated above the level where it should be. 
We offered the patient robotic plication after optimization of his congestive heart failure. Risks, benefits, and alternatives were discussed with the patient and he agreed to Proceed. He understood the risk of death, MI, stroke, bleeding, infection, poor transfusion, would complication, failure of the procedure mechanically, failure of the procedure to alleviate his symptomatology. He agreed to proceed.

PROCEDURE: The patient was taken to the operating room and placed in supine. He underwent general endotracheal anesthesia. I performed fiberoptic bronchoscopy, which revealed normal endobronchial anatomy. We next placed a double-lumen tube and turned the patient to right side up decubitus position, prepped and draped in a standard surgical fashion. I used four robotic arms plus utility port to conduct repair. There was a severe eventration of the diaphragm. I used the tip-up grasper to very carefully and slowly reduce the diaphragm and gradually reduced it to physiologic position. I then performed plication using Dacron pledgets and using a a V-Loc running suture over multiple layers. The repair was excellent, reestablished to normal position for the diaphragm and hemostasis was excellent. Next, the chest was inspected for hemostasis. I also inspected the lung for adhesions as well as areas of atelectasis. We drained a pleural effusion. Multiple intercostal and paravertebral nerve blocks were placed. There was no adhesiolysis that was necessary. After the tunneled chest tube was placed, the lung was reexpanded. A Valsalva was applied to help the lung expand into its new domain. Incisions were closed in layers with sterile sutures. Sponge, needle, and instrument counts were correct. At the conclusion of the case, there were no complications.


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## csperoni (May 20, 2022)

I do not see any laparoscopic codes to accurately explain this work.  While there is an open code as you mentioned (39545), you may not use an open code to describe a laparoscopic procedure simply because the laparoscopic code does not exist.  You must use unlisted and benchmark it to the closest code.  You can decide whether you think it is the same work as the open code, more work, or less work.


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## Daisymm (May 23, 2022)

Hello,
Thanks for the reply. Helps to know that I was on the right track.   I'll go with the unlisted w comparison code noted.


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