General Surgery Coding Alert

Question: A boy with cerebral palsy who had a gastrostomy in 1994 recently complained of abdominal pain. It was determined that the incision from the gastrostomy had migrated over the lower costal margin, causing a pulling effect on the stomach. Adhesions were lysed via laparotomy, and the tract was excised. The stomach then returned to its normal anatomic position. The diagnosis was tethered gastrostomy. How should excision of the gastrostomy tract be coded?

Michigan Subscriber
Answer: The gastrostomy tract described here appears to be similar to an adhesion. A gastrostomy involves the creation of an opening directly into the stomach for feeding purposes. As the child grew, the skin stretched and caused the scar from the previous incision to move. The removal of the tethered gastrostomy tract is similar to a scar revision, except that the surgeon must also go in and cut the tethered stomach free.
 
Although there is no code for freeing a tethered gastrostomy from the abdominal wall, the procedure very closely resembled lysis of adhesions (44005). Given the fact that when the gastrostomy was taken down (1994) and a laparotomy to disconnect the gastrostomy from the abdominal wall was also performed, it is likely a kind of adhesion was keeping the stomach tethered to the abdominal wall. Therefore, this service should be reported with 44005.