Can I please get CPT help from you wonderful coders and possible Modifiers. Thank you!
1. Expl Lap
2. Extensive lysis of adhesions, including takedown of the splenic flexure
3. Resection of gastric ulcer
4. Vagotomy and Pyloroplasty
Incision above previous midline incision and connected to previous incision. Carried through subcutaneous tissues to fascia which was incised. Abdomen entered. There was significant adhesive disease throughout abdomen. Colon was dilated and loops of colon appeared adherent to what was thougth to be the stomach. The liver was covered with adhesions. Procedure began w/extensive adhesiolysis lasting 1 hour before stomach, as a separate entity, was able to be identified from the significant epigastric scarring. The dilated twisted colon had to be moved out of the way so splenic flexure was carefully dissected and taken down w/ligasure and electrocautery. After significant dissections in the plane between colon and stomach could be identified, there was space to develop and indentify the lesser sac. Stomach was then grasped and elevated, gastrocolic ligaments divided and colon was able to be moved out of operative field. Adhesions between stomach and liver were divided using electrocautery and ligasure and sharp dissection. After mobilization, gastrohepatic ligament was identified and divided. Triangular ligament dissected free and divided as was falciform ligament. This allowed left edge of liver to fold out of way to allow complete mobilization of stomach. Ulcers had been discribed as being close to GE junction so a decison was made to mobilize the espohagus and allow for the potential that resection could include a portion of the GE junction if needed. Teh peritoneum of stomach then incised and anterior of esophagus then able to be encircled and mobilized. The exam of the stomach noted gastrogastrostomy appeared to be intact and stapled anastomotic line could identified. A proximal gastrostomy was mad and carried down to mucosa where digital palpation was abel to verify that this was the site of the anastomotic line. This site of the stomach then everted and ulcerated region was identiofied across previously placed staple line. Ulcer grasped and elevated and circumferentially dissected from the surrounding stomach. Ulcer then passed off. Decision made to perform acid suppression. Previously noted esophageal mobilization had allowed for the correct visualization of the vagus nerves, which were individually clipped and divided with a segment sent off. Transverse incision made through pylorus, which was then closed in longitudinal fashing using suture. Teh gastrostomy then closed and irrigated. Midline incision closed. Dressings applied.
1. Expl Lap
2. Extensive lysis of adhesions, including takedown of the splenic flexure
3. Resection of gastric ulcer
4. Vagotomy and Pyloroplasty
Incision above previous midline incision and connected to previous incision. Carried through subcutaneous tissues to fascia which was incised. Abdomen entered. There was significant adhesive disease throughout abdomen. Colon was dilated and loops of colon appeared adherent to what was thougth to be the stomach. The liver was covered with adhesions. Procedure began w/extensive adhesiolysis lasting 1 hour before stomach, as a separate entity, was able to be identified from the significant epigastric scarring. The dilated twisted colon had to be moved out of the way so splenic flexure was carefully dissected and taken down w/ligasure and electrocautery. After significant dissections in the plane between colon and stomach could be identified, there was space to develop and indentify the lesser sac. Stomach was then grasped and elevated, gastrocolic ligaments divided and colon was able to be moved out of operative field. Adhesions between stomach and liver were divided using electrocautery and ligasure and sharp dissection. After mobilization, gastrohepatic ligament was identified and divided. Triangular ligament dissected free and divided as was falciform ligament. This allowed left edge of liver to fold out of way to allow complete mobilization of stomach. Ulcers had been discribed as being close to GE junction so a decison was made to mobilize the espohagus and allow for the potential that resection could include a portion of the GE junction if needed. Teh peritoneum of stomach then incised and anterior of esophagus then able to be encircled and mobilized. The exam of the stomach noted gastrogastrostomy appeared to be intact and stapled anastomotic line could identified. A proximal gastrostomy was mad and carried down to mucosa where digital palpation was abel to verify that this was the site of the anastomotic line. This site of the stomach then everted and ulcerated region was identiofied across previously placed staple line. Ulcer grasped and elevated and circumferentially dissected from the surrounding stomach. Ulcer then passed off. Decision made to perform acid suppression. Previously noted esophageal mobilization had allowed for the correct visualization of the vagus nerves, which were individually clipped and divided with a segment sent off. Transverse incision made through pylorus, which was then closed in longitudinal fashing using suture. Teh gastrostomy then closed and irrigated. Midline incision closed. Dressings applied.