General Surgery Coding Alert

Question: We had a patient return with complications following a gastric bypass procedure. Our surgeon performed a laparoscopic repair of a perforation at the gastro-jejunostomy anastomosis by suturing the site and then performing a patch with omentum at the repair site. Should I code this as 43840 or 43860?

Tennessee Subscriber

Answer: No, you should not report this procedure as 43840 (Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury) or 43860 (Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; without vagotomy). Both codes describe an open procedure, and you indicate that your surgeon treated this laparoscopically. Also, code 43860 describes a more extensive revision than suturing and patching a perforation.

Instead, you'll need to report a laparoscopic code, but CPT^® does not provide a specific code for laparoscopic gastrorrhaphy. That means you'll need to turn to the unlisted code, 43659 (Unlisted laparoscopy procedure, stomach).

Addition: Because your surgeon also placed an omental flap, you can separately code for that work. Again, you face the problem that the add-on code describing that work (+49905, Omental flap, intra-abdominal (List separately in addition to code for primary procedure)) is for an open procedure, not a laparoscopic procedure.

Solution: You'll have to use another unlisted code forthe omental flap, this time turning to 49329 (Unlisted laparoscopy procedure, abdomen, peritoneum and omentum).