pclaybaugh
Networker
Thanks so much for all the help...I have used 43820 thus far, but I feel that I have not nailed the correct code and am I missing a vagotomy? I would love some assistance. I am not a gastro coder and am filling in....
The provider is calling this "Laparoscopic roux en y gastric drainage procedure"
An incision was made in the medial lower left upper quadrant and dissection was carried down through subcutaneous tissues to the anterior abdominal wall fascia.The anterior abdominal wall fascia was elevated and incised and blunt entry into the peritoneum was achieved using a Kelly clamp.A Hassan cannula was inserted into the abdomen and secured using stay sutures.The abdomen was insufflated to 15 mmHg.The patient tolerated insufflation well.
A 30° laparoscope was inserted and the abdomen inspected. No injury from the initial trocar placement was identified.4 5MM secondary trocars were placed in the right lower & upper quadrant, left upper quadrant and suprapubic region under direct visualization .A Babcock clamp was inserted and the abdomen inspected. As was suspected pre-op the first and second portion of the duodenum were in a hostile field with dense adhesions to the gall bladder, pancreas, distal stomach stomach and liver.The gastrocolic ligament was divided as distally as was feasible to create a posterior gastric gastrojejunostomy to facilitate drainage. The omentum was swept cephalad.The colon was elevated and the ligament of Treitz was identified. The small bowel was then run distally for about 50-75 cm. This was marked with a stitch to mark the future gastrojejunal anastomosis.The small bowel was then divided with a linear laparoscopic stapler with blue loads. A side to side jejunojejunostomy was then fashioned another 50-75 cm distally using a single firing of a 40mm linear cutting stapler with blue loads. Shorter limbs were used to avoid weight loss in this patient who had lost 40 lbs unintentionally in the last year. The common enterotomy was then closed with sutures of Vicryl and Polysorb.Attention was then directed to the gastrojejunal limb which was brought up in an antecolic position.The end was dusky so 7cm was resected with a stapler. This was placed in an EndoCatch bag and removed at the conclusion of the case.A distal posterior gastrotomy was made. An enterotomy was made about 6 cm proximally on the jejunum.A 60mm linear cutting stapler with green loads was inserted into the posterior gastrotomy and the enterotomy and fired.Theis created a long and consequently stricture resistant gastrojejunal anastomosis.The common channel was closed with sutures of 0 Polysorb. The patient was positioned in the Trendelenburg position and the gastrojejunal anastomosis was covered with irrigation. Endoscopy was performed and the anastomosis was inspected, was widely patent and did not leak air into the peritoneal cavity.T he Peterson's defect was then closed with a running suture of Surgidac. A 15F drain was brought out through the left upper quadrant port site and the round fluted portion was positioned in the retrogastric position adjacent to the anastomosis. The abdomen was irrigated and the irrigation aspirated.Secondary trocars were removed under direct visualization. The abdomen was allowed to desufflate. The fascia of the Hassan cannula site was closed using figure-of-eight sutures of 0 Vicryl.All skin incisions were hemostatic and closed using subcuticular sutures of 4-0 Monocryl. The drain was secured with 3-0 nylon. The wounds were dressed with Dermabond. The Foley catheter was removed.
The provider is calling this "Laparoscopic roux en y gastric drainage procedure"
An incision was made in the medial lower left upper quadrant and dissection was carried down through subcutaneous tissues to the anterior abdominal wall fascia.The anterior abdominal wall fascia was elevated and incised and blunt entry into the peritoneum was achieved using a Kelly clamp.A Hassan cannula was inserted into the abdomen and secured using stay sutures.The abdomen was insufflated to 15 mmHg.The patient tolerated insufflation well.
A 30° laparoscope was inserted and the abdomen inspected. No injury from the initial trocar placement was identified.4 5MM secondary trocars were placed in the right lower & upper quadrant, left upper quadrant and suprapubic region under direct visualization .A Babcock clamp was inserted and the abdomen inspected. As was suspected pre-op the first and second portion of the duodenum were in a hostile field with dense adhesions to the gall bladder, pancreas, distal stomach stomach and liver.The gastrocolic ligament was divided as distally as was feasible to create a posterior gastric gastrojejunostomy to facilitate drainage. The omentum was swept cephalad.The colon was elevated and the ligament of Treitz was identified. The small bowel was then run distally for about 50-75 cm. This was marked with a stitch to mark the future gastrojejunal anastomosis.The small bowel was then divided with a linear laparoscopic stapler with blue loads. A side to side jejunojejunostomy was then fashioned another 50-75 cm distally using a single firing of a 40mm linear cutting stapler with blue loads. Shorter limbs were used to avoid weight loss in this patient who had lost 40 lbs unintentionally in the last year. The common enterotomy was then closed with sutures of Vicryl and Polysorb.Attention was then directed to the gastrojejunal limb which was brought up in an antecolic position.The end was dusky so 7cm was resected with a stapler. This was placed in an EndoCatch bag and removed at the conclusion of the case.A distal posterior gastrotomy was made. An enterotomy was made about 6 cm proximally on the jejunum.A 60mm linear cutting stapler with green loads was inserted into the posterior gastrotomy and the enterotomy and fired.Theis created a long and consequently stricture resistant gastrojejunal anastomosis.The common channel was closed with sutures of 0 Polysorb. The patient was positioned in the Trendelenburg position and the gastrojejunal anastomosis was covered with irrigation. Endoscopy was performed and the anastomosis was inspected, was widely patent and did not leak air into the peritoneal cavity.T he Peterson's defect was then closed with a running suture of Surgidac. A 15F drain was brought out through the left upper quadrant port site and the round fluted portion was positioned in the retrogastric position adjacent to the anastomosis. The abdomen was irrigated and the irrigation aspirated.Secondary trocars were removed under direct visualization. The abdomen was allowed to desufflate. The fascia of the Hassan cannula site was closed using figure-of-eight sutures of 0 Vicryl.All skin incisions were hemostatic and closed using subcuticular sutures of 4-0 Monocryl. The drain was secured with 3-0 nylon. The wounds were dressed with Dermabond. The Foley catheter was removed.