Wiki LAP Esophagectomy/and Thoracotomy

[cmblocher]

I need help, this operative report has me pulling out my hair.
Here are listed procedures
1. EGD- Diagnostic
2. Laparoscopic Esophagectomy with a right mini-thoracotomy (IVOR LEWIS)
3. Mediastinal lymph node dissection
4. Takedown of Previous gastrostomy, with lysis of adhesions taking 1 hour of extra time

43117 is for the Ivor Lewis esophagectomy, if done with a Thoracotomy, and seperate abdominal incision. Since he did the abdominal portion laparoscopically, I was unsure if I should bill that part with unlisted code 43289 and bill for the thoracotomy portion with 43121????

Next, should I bill for the takedown of the gastrostomy, or would you consider this an integral part of 44121?

There are no CPT codes for lysis of abominal adheisions, should I add modifer 22. OR should I just consider this in with thoracotomy approach?

I can give more details from the op note, if you need.
Thanks for help ahead of time!

 

[lisigirl]

I'm not 100% sure on the takedown of the gastrostomy. As for the rest, I would code the entire esophagectomy with CPT 43289. I would include the lysis of adhesions when setting your fee for this unlisted code (You can't bill separately for them but when the work to take them down is significant, you can add modifier 22. Since this is an unlisted code though, don't add the modifier, just increase your fee).

I would also bill 38746 for the mediastinal lymph node dissection. The surgeon should be documenting he/she removed lymph nodes from levels 4,7, and 9 (at a minimum) to bill for this though.

Lisi, CPC