peporter
Guru
Hello coders, Does anyone have a cpt code for a laparoscopic partial gastrectomy?
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Wiki cpt code needed for a laparoscopic partial gastrectomy
- Thread starter peporter
- Start date
Without looking at the report, here are some of the CPT codes you may want to look at 
43631- Gastrectomy, partial distal, with gastroduodenostomy
43632- with gastrojejunostomy
43633- with Roux-enY reconstruction
43634- with formation of intestinal pouch
Laparoscopy area with gastrectomy is 43775and 43845 also involves a partial gastrectomy.
Hope this helps depending on what the dictation is
43631- Gastrectomy, partial distal, with gastroduodenostomy
43632- with gastrojejunostomy
43633- with Roux-enY reconstruction
43634- with formation of intestinal pouch
Laparoscopy area with gastrectomy is 43775and 43845 also involves a partial gastrectomy.
Hope this helps depending on what the dictation is
JRPayne
New
Need more information
If partial gastrectomy was performed, was it distal or proximal? Coding partial gastrectomy can be more complicated, as it can be either distal or proximal. CPT's distal partial gastrectomy series is broken down in roughly the same manner as the total gastrectomy series: 43631 (Gastrectomy, partial, distal; with gastroduodenostomy), 43632 ( with gastrojejunostomy), 43633 ( with Roux-en-Y reconstruction) and 43634 ( with formation of intestinal pouch). Two other codes cover proximal partial gastrectomy: 43638 (Gastrectomy, partial, proximal, thoracic or abdominal approach including esophagogastrostomy, with vagotomy) and 43639 ( with pyloroplasty or pyloromyotomy).
http://www.supercoder.com/articles/...ural-notes-anatomy-and-terminology-are-vital/
If partial gastrectomy was performed, was it distal or proximal? Coding partial gastrectomy can be more complicated, as it can be either distal or proximal. CPT's distal partial gastrectomy series is broken down in roughly the same manner as the total gastrectomy series: 43631 (Gastrectomy, partial, distal; with gastroduodenostomy), 43632 ( with gastrojejunostomy), 43633 ( with Roux-en-Y reconstruction) and 43634 ( with formation of intestinal pouch). Two other codes cover proximal partial gastrectomy: 43638 (Gastrectomy, partial, proximal, thoracic or abdominal approach including esophagogastrostomy, with vagotomy) and 43639 ( with pyloroplasty or pyloromyotomy).
http://www.supercoder.com/articles/...ural-notes-anatomy-and-terminology-are-vital/
I think we would need a redacted op report to really give some advice. The code can depend on a lot of different factors!
peporter
Guru
Thanks for all the responses. Here is part of the op note:
OPERATIONS
1. Laparoscopic paraesophageal hiatal hernia repair with mesh (7 cm x
10 cm bio design Cook mesh).
2. Diagnostic laparoscopy.
3. Laparoscopic lysis of adhesions.
4. Laparoscopic partial gastrectomy.
5. Intraoperative esophagogastroduodenoscopy.
6. laparoscopic placement of Jackson-Pratt drain x1.
7. Laparoscopic liver biopsy.
8. Placement of On-Q pain catheter x2.
A Nathanson liver retractor was then placed through the subxiphoid
fascial defect in order to retract the left lobe of the liver
atraumatically.
At this time, I encountered a very significant and large hiatal hernia.
I estimate it to be approximately 6 cm in diameter. Approximately 50%
of the stomach was incarcerated through this hernia cephalad into the
chest. A large amount of omentum was also incarcerated through this
hernia into the chest.
Next, I carefully mobilized the stomach back into the abdominal cavity.
This allowed me to reduce all of the stomach all way to the
gastroesophageal junction and into the abdominal cavity. I carefully
dissected the hernia sac. The right and left crura of the diaphragm
were carefully dissected. Great care was maintained in not violating
the integrity of the esophagus.
Next, I mobilized the stomach and gastroesophageal junction laterally.
This enabled me to visualize the posterior portions of the right and
left crura, at which point they meet in the retroperitoneum. Great care
was maintained in not injuring the inferior vena cava nor the left
gastric vessels. The entire crura were skeletonized and dissected
circumferentially.
Next, I utilized the Endo stitch device with 2-0 silk suture to
reapproximate the crura posteriorly. Several interrupted stitches were
utilized. At this time, a 50-French bougie was placed by the
anesthesiologist transorally without difficulty. I could witness the
bougie traversing down the esophagus and across the gastroesophageal
junction into the proximal portion of the stomach. I next proceeded
with closure of the hiatus anterior to the gastroesophageal junction.
Next, a 7 cm x 10 cm bio design Cook hiatal mesh was brought onto the
operative field and appropriately prepared. It was placed in the
abdominal cavity, and the wide portion of the mesh with the horseshoe
shaped cutout facing anterior was placed on the medial side of the
abdomen.
I next utilized several 2-0 silk sutures with the Endo stitch device to
secure the mesh in place circumferentially around the GE junction.
Great care again was maintained to not injuring the esophagus or
stomach. A similar maneuver was performed laterally. However, the 2
lips or tabs of the mesh was not connected anterior to the esophagus.
Satisfied with the placement of this mesh and the closure of the large
hiatal hernia, I next began dissection of the greater curvature of the
stomach. The Harmonic scalpel was utilized to begin taking down the
gastroepiploic vessels. This dissection was carried along the entire
greater curvature of the stomach through the gastroepiploic and short
gastric vessels all way to the angle of His.
I felt that it was important to perform a volume reducing procedure on
the stomach. The stomach was extremely lengthened and floppy. Now that
it had brought down in the abdominal cavity, I was certainly concerned
about the occurrence of a volvulus which could be potentially
life-threatening.
The echelon 60 flex staple gun with gold cartridge was next fired onto
the stomach approximately 6 cm proximal to the pylorus. I carried out
multiple fires of the staple gun with green cartridge and Surgisis bio
design buttressing material along the greater curvature of the stomach,
excising most of the body of the stomach and all the fundus of the
stomach all way to the angle of His. I essentially reduced the size and
volume of the stomach in half.
The staple line was carefully inspected. It was determined to be
hemostatic and intact.
I next utilized a bowel clamp and clamped the stomach distally just
proximal to the pylorus. Next, an intraoperative EGD was performed by
myself. The endoscope was carefully placed into the oropharynx was
traversed down the esophagus. The esophagus was unremarkable.
Approximately 35 cm from the incisors, I traversed the gastroesophageal
junction and entered the body of the stomach. I could visualize the
staple line, and it was, again, intact and hemostatic. The endoscope
was traversed all the way to the area of the clamp just proximal to the
pylorus. The stomach dilated with air, and it was submerged under
saline. There was no bubbling of air, again, confirming an intact
staple line.
OPERATIONS
1. Laparoscopic paraesophageal hiatal hernia repair with mesh (7 cm x
10 cm bio design Cook mesh).
2. Diagnostic laparoscopy.
3. Laparoscopic lysis of adhesions.
4. Laparoscopic partial gastrectomy.
5. Intraoperative esophagogastroduodenoscopy.
6. laparoscopic placement of Jackson-Pratt drain x1.
7. Laparoscopic liver biopsy.
8. Placement of On-Q pain catheter x2.
A Nathanson liver retractor was then placed through the subxiphoid
fascial defect in order to retract the left lobe of the liver
atraumatically.
At this time, I encountered a very significant and large hiatal hernia.
I estimate it to be approximately 6 cm in diameter. Approximately 50%
of the stomach was incarcerated through this hernia cephalad into the
chest. A large amount of omentum was also incarcerated through this
hernia into the chest.
Next, I carefully mobilized the stomach back into the abdominal cavity.
This allowed me to reduce all of the stomach all way to the
gastroesophageal junction and into the abdominal cavity. I carefully
dissected the hernia sac. The right and left crura of the diaphragm
were carefully dissected. Great care was maintained in not violating
the integrity of the esophagus.
Next, I mobilized the stomach and gastroesophageal junction laterally.
This enabled me to visualize the posterior portions of the right and
left crura, at which point they meet in the retroperitoneum. Great care
was maintained in not injuring the inferior vena cava nor the left
gastric vessels. The entire crura were skeletonized and dissected
circumferentially.
Next, I utilized the Endo stitch device with 2-0 silk suture to
reapproximate the crura posteriorly. Several interrupted stitches were
utilized. At this time, a 50-French bougie was placed by the
anesthesiologist transorally without difficulty. I could witness the
bougie traversing down the esophagus and across the gastroesophageal
junction into the proximal portion of the stomach. I next proceeded
with closure of the hiatus anterior to the gastroesophageal junction.
Next, a 7 cm x 10 cm bio design Cook hiatal mesh was brought onto the
operative field and appropriately prepared. It was placed in the
abdominal cavity, and the wide portion of the mesh with the horseshoe
shaped cutout facing anterior was placed on the medial side of the
abdomen.
I next utilized several 2-0 silk sutures with the Endo stitch device to
secure the mesh in place circumferentially around the GE junction.
Great care again was maintained to not injuring the esophagus or
stomach. A similar maneuver was performed laterally. However, the 2
lips or tabs of the mesh was not connected anterior to the esophagus.
Satisfied with the placement of this mesh and the closure of the large
hiatal hernia, I next began dissection of the greater curvature of the
stomach. The Harmonic scalpel was utilized to begin taking down the
gastroepiploic vessels. This dissection was carried along the entire
greater curvature of the stomach through the gastroepiploic and short
gastric vessels all way to the angle of His.
I felt that it was important to perform a volume reducing procedure on
the stomach. The stomach was extremely lengthened and floppy. Now that
it had brought down in the abdominal cavity, I was certainly concerned
about the occurrence of a volvulus which could be potentially
life-threatening.
The echelon 60 flex staple gun with gold cartridge was next fired onto
the stomach approximately 6 cm proximal to the pylorus. I carried out
multiple fires of the staple gun with green cartridge and Surgisis bio
design buttressing material along the greater curvature of the stomach,
excising most of the body of the stomach and all the fundus of the
stomach all way to the angle of His. I essentially reduced the size and
volume of the stomach in half.
The staple line was carefully inspected. It was determined to be
hemostatic and intact.
I next utilized a bowel clamp and clamped the stomach distally just
proximal to the pylorus. Next, an intraoperative EGD was performed by
myself. The endoscope was carefully placed into the oropharynx was
traversed down the esophagus. The esophagus was unremarkable.
Approximately 35 cm from the incisors, I traversed the gastroesophageal
junction and entered the body of the stomach. I could visualize the
staple line, and it was, again, intact and hemostatic. The endoscope
was traversed all the way to the area of the clamp just proximal to the
pylorus. The stomach dilated with air, and it was submerged under
saline. There was no bubbling of air, again, confirming an intact
staple line.
peporter
Guru
Op note attached
Happy New Year Coders, I have attached the op note to see if anyone can help find the correct code for the partial gastrectomy. Thanks in advance for any help. Paula
Happy New Year Coders, I have attached the op note to see if anyone can help find the correct code for the partial gastrectomy. Thanks in advance for any help. Paula