# Revision of previous vertical banding gastroplasty



## renee.lyle (Oct 13, 2009)

Pt previously had lap band few years ago by previous doctor. My doctor took her to surgery for severe gastric stricture. 

Gastric stapling was identified along the greater curvature along with the prosthesis. Could not see the band and not be reached easily without causing any significant damage to the stomach. Performed Roux-en-Y gastrojejunostomy anastomosis to the proximal functioning gastric pouch. We went 50 cm distal to the ligament of Treitz. SM bowel was divided, jejunostomy anastomosis was created in a side to side fashion, and jejunostomy anastomosis was closed again. Roux limb was brought up to the proximal portion of the gastric pouch and pouch was entered. Stapler was used to create the gastric jejunostomy anastomosis again to the proximal portion of the gastric pouch.

I am not really confident on how to bill this. I was looking at 43820 but not quite sure. Any input would be greatly appreciated.


----------



## mjewett (Oct 13, 2009)

I was thinking code 43848 would work. The General Surgery Coding Companion's description of this codes states. "Indications for revision include stomal stenosis......Revision technique vary depending on the technique used in the intial gastric restrictive procedure, and the nature of the gastric restrictive failure.  Types of revision include gastroplasty, conversion of a gastroplasty to a gastric bypass, and revision of gastric bypass."

I think performing a roux-en Y to correct a severe stricture, after the patient has had a previous gastric restrictive procedure would consitute using code 43848.

Hope this helps,


----------



## ednessa (Dec 22, 2009)

Hello, 
please help, my surgeon performed a similar prodedure except it was done laparoscopic,he listed as: Laparoscopic conversion of vertical banded gastroplasty to Roux-en-Y gastric bypass, post op DX, severe gastroesophageal reflux disease, status post vertical banded gastroplasty in the '80s,
I was thinking 43659 unlisted lap.?? ... 

Thanks
AC


----------

