Gastroenterology Coding Alert

Question: Our gastroenterologist recently performed an exploratory laparotomy, liver biopsy, gastrojejunostomy with placement of a gastrostomy and jejunostomy tube along cholecystojejunostomy on a 55-year-old patient.

The procedure notes read, "A midline incision was performed and carried through skin and subcutaneous tissue. The peritoneal cavity was entered. Upon entering the abdomen, he was found to have multiple small liver metastases involving both lobes of the liver. A small wedge biopsy of the liver was performed to encompass a nodule that was located at the very surface of the left lateral segment of the liver. Cautery was used for hemostasis. He had a mass on the pancreas, swollen gallbladder. I decided to bypass his stomach with the gastrojejunostomy, and bring up a loop of small bowel in order to perform cholecystojejunostomy, since his common bile duct was not enlarged. Instead of passing a single tube, the decision was made to place both the gastrostomy tube for drainage and a separate jejunostomy tube for feeding. Before tacking to the anterior abdominal wall, it was decided to create a cholecystojejunostomy. Once the anvil was placed a whipstitch was performed around the gallbladder and the other end of the EEA was passed through. The 2 ends were brought together and the EEA device was fired. When placing the drain the entire anastomosis fell apart, so a hand anastomosis was performed instead."

Massachusetts Subscriber

Answer: Going by the procedure notes, here is the list of codes that you will have to report for the procedures that your gastroenterologist performed:

• 47100 (Biopsy of liver, wedge) to report the wedge liver biopsy;
• 47741 (Cholecystoenterostomy; Roux-en-Y with gastroenterostomy) to report the cholecystojejunostomy. Since the descriptor includes "gastroenterostomy" you cannot code the gastrojejunostomy separately as it is included in the same procedure;
• 49440 (Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection[s], image documentation and report) to report the placement of the gastrostomy tube; and
• 49441 (Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report) to report the placement of the jejunostomy tube.

Since there are no Correct Coding Initiative (CCI) edits to report all these above mentioned procedural codes together, you can report these codes separately without having to use any special modifiers.