# Manual reduction of incarcerated paraesophageal hernia



## lindacoder (Mar 9, 2010)

Need help with the following:

Upper midline incision was made and gentle traction was placed on the stomach. The hiatal opening was stretched and more bloody fluid came from this. This took enough out of the stomach that it could now be reduced down into the peritoneal cavity. The fundus of the stomach especially flaccid with some ischemic changes; however the longer it had been reduced the better the appearance. The hernia sac was then incised along the edge of the hiatus especially anteriorly and on the left side;  however there was a great amount of edema here and the stomach continued to be so significantly dilated that exposure was not good. The nasogastric tube was repositioned in the stomach but because of the nature of the contents of the stomach this could not easily be suctioned.  Therefore, a gastrostomy tube was placed to help deal with this problem.  Two 3-0 Vicryl pursestring sutures were placed on the antrum near the greater curve. The gastrostomy tube was placed in this and the balloon inflated. This still did not successfully decompress the stomach because of the vegetable matter and undigested food in the stomach. Decision was made to forego any attempts to repair the hernia. Artificial mesh would carry too high of a arisk on infection or eroding into this compressed stomach. Dissolvable mesh would probably not provide any satisfactory long-term effect and primary suturing had the potential to tear the hiatus and enlarging the defect. Therefore, 3-0 Vicryl sutures were placed to perform a gastropexy up along the fundus and the undersurface of the diaphragm and then the gastrostomy tube was repositioned through the left upper quadrant abdominal wall and back down into the lumen of the stomach. The balloon was again inflated, another purse-string suture was placed and then four sutures were placed around the periphery of the stomach at the site of the gastrostomy exit to secure it.

Patient has Medicare - is unlisted CPT code just about my only option??????  
Thanks


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## mjewett (Mar 9, 2010)

I would bill only for the Gastrostomy 43830.


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## FTessaBartels (Mar 9, 2010)

*53 modifier*

This sounds like a perfect case for using the -53 modifier. 

List the code for the procedure the surgeon PLANNED to perform, and append a -53 modifier (Discontinued procedure).

Hope that helps.

F Tessa Bartels, CPC, CEMC


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