General Surgery Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: The patient is diagnosed with necrotizing pancreatitis. The surgeon performs an exploratory laparotomy with drainage and debridement of pancreatic phlegmon, cholecystectomy with exploration of the common bile duct, feeding jejunostomy, tube gastrostomy and sump drainage of the pancreatic bed through both flanks. How should this be billed?

California Subscriber

    Answer: Bill 48005 (resection or debridement of pancreas and peripancreatic tissue for acute necrotizing pancreatitis), 47610 (cholecystectomy with exploration of common duct), 44015 (tube or needle catheter jejunostomy for enteral alimentation, intraoperative, any method [list separately in addition to primary procedure]) and 43750 (percutaneous placement of gastrostomy tube).
 
The primary procedure is the pancreas resection, which should be reimbursed at 100 percent. The cholecystectomy and the gastrostomy tube placement will be paid at 50 percent (per multiple procedure guidelines). The jejunostomy should be paid at 100 percent because it is an add-on code and already reduced. Sump drainage is included in 48005 and should not be billed separately.