# Open tube gastrostomy versus PEG



## trinalankford (Jun 18, 2012)

I'm completely stuck on this CPT code.

The patient is brought to the OR. The videogastroscope was inspected and found to be in working condition. The patient was given a general anesthetic. I inserted the tube orally, finding copious saliva and food in the back of the throat. The instrument was advanced under direct vision only a distance of 20 cm, at which point it would not go further due to circumferential stricturing. This did not appear to be a short segment. There was considerable resistance, even to gentle pressure. I abandoned this procedure in favor of converting to an open operation.

The abdomen was prepped and draped with sterile towels. A short incision was made using sterile technique through the previous tube gastrostomy site in the LUQ of the abdomen. Dissection was carried down through the rectus muscle and through the internal rectus sheath, identifying the anterior wall of the stomach adherent at this point secondary to the previous tube placement. Two stay sutures of 3-0 chromic were placed in the stomach which was then opened with electrocautery. The PEG was actually placed through this open gastrotomy. The mucosa was closed with interrupted 2-0 chromic. The muscular layer was closed with interrupted 3-0 silk. The fascia was then closed with 2-0 Vicryl, catching the stomach in at least 3 locations and pexying it again to the anterior abdominal wall. Anterior fascia was closed in the same manner. Skin was closed with interrupted subcuticular 4-0 Vicryl. The PEG tube retention device was then sutured to the skin with 3-0 sutures of 3-0 Prolene. Wound margins were injected with Ropivacaine. Sterile dressing was applied. The patient tolerated this procedure well.

I'm debating between 49440 and 43832, but the procedure prices that I see seem to be much higher than the complexity of the procedure.

Thank you for your help!


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