Michele1229
Networker
Hello surgical coders -
I need some help. We had a patient who had a partial gastrectomy. The duodenal stump blew out 10 days later so my docs are back in the OR. I know I need a 78 modifier but I am unsure how to code what they did. Please see below. I tried researching but my situation does not seem to have come up anywhere I can find. And if a unlisted code is appropriate any suggestions on cost comparison codes?
Thanks in advance!
The peritoneal cavity is thoroughly irrigated with over 14L of sterile saline. Small bowel intact. The duodenal stump is found to have blown out, it has a cratered appearance. There is no purulence. There is not FB. It is extremely indurated, firm and thickened and cannot easily be mobilized. A 24 French foley catheter is left as a duodenal tube and the balloon is insufflated with 5ml of saline. This allowed the IR drain catheter to be removed (this was placed before surgery to see if they could avoid surgery). The duodenal tube is then secured with vicryl suture in multiple locations to prevent migration. The omentum is mobilized off the transverse colon and is healthy, soft and supple. This is then placed throughout the cratered duodenal stump and around the duodenal tube. It has good blood supply. The right upper quadrant is then drained with a 10mm Jackson-pratt and then this is brought out the RUQ. Hemostasis assured., The fascia is cleaned up as best as possible. It is felt that the patient is at high risk of fascial dehiscence therefore underlay absorbable mesh is used for complex wound closure. The midline fascia is closed as best as possible over absorbale mesh with 0-looped pds suture from above and below. Sutures used for internal retention and hemostasis is assured.
I need some help. We had a patient who had a partial gastrectomy. The duodenal stump blew out 10 days later so my docs are back in the OR. I know I need a 78 modifier but I am unsure how to code what they did. Please see below. I tried researching but my situation does not seem to have come up anywhere I can find. And if a unlisted code is appropriate any suggestions on cost comparison codes?
Thanks in advance!
The peritoneal cavity is thoroughly irrigated with over 14L of sterile saline. Small bowel intact. The duodenal stump is found to have blown out, it has a cratered appearance. There is no purulence. There is not FB. It is extremely indurated, firm and thickened and cannot easily be mobilized. A 24 French foley catheter is left as a duodenal tube and the balloon is insufflated with 5ml of saline. This allowed the IR drain catheter to be removed (this was placed before surgery to see if they could avoid surgery). The duodenal tube is then secured with vicryl suture in multiple locations to prevent migration. The omentum is mobilized off the transverse colon and is healthy, soft and supple. This is then placed throughout the cratered duodenal stump and around the duodenal tube. It has good blood supply. The right upper quadrant is then drained with a 10mm Jackson-pratt and then this is brought out the RUQ. Hemostasis assured., The fascia is cleaned up as best as possible. It is felt that the patient is at high risk of fascial dehiscence therefore underlay absorbable mesh is used for complex wound closure. The midline fascia is closed as best as possible over absorbale mesh with 0-looped pds suture from above and below. Sutures used for internal retention and hemostasis is assured.