Can I get your advice on CPT's for this please. I'm thinking 43653 but there was more of an explore ??
The patient was brought to the operating room, and placed in the supine position. General endotracheal anesthesia was then established. The abdomen was prepped and draped in standard fashion. A midline intraumbilical incision was made and carried through the subcutaneous tissue to the fascia at the base of the umbilicus. The fascia incised. Heavy Vicryl was placed on either side of the fascial defect. The 5mm trocar was entered through the defect into the abdomen. Pneumoperitoneum was established. The abdomen examined with laparoscope. There was no evidence of injury to the bowel secondary to port placement noted. A 5 mm left upper quadrant port was placed under direct vision. The endoscope was advanced into the mouth and introduced into esophagus. The scope was passed through the esophagus and gently insufflated as it entered the stomach. The stomach expanded appropriately. The laparoscopic needle was introduced into stomach through the LUQ port. The guidewire was advanced through the needle under endoscopic guidance. A endoscopic wire snare was used to grasp the guidewire. Once attachment was confirmed, the scope was withdrawn and the guidewire pulled through. The PEG introducer was placed over the guidewire. The wire was retracted and PEG introducer was advanced into the stomach and out through the port site. The guidewire was removed. The endoscope was re-introduced. The PEG tube was noted to be against the abdominal wall. The pneumoperitoneum was allowed to resolve and the remaining port removed. The previously placed Vicryl sutures through the fascial defect were then tied and there was no evidence of hernia noted. The skin was closed using running 4-0 subcuticular sutures. Steri-Strips and dressings were applied. The endoscope was removed and air aspirated from the stomach as it was withdrawn. The tube collar was advanced onto the skin and secured. The tube was trimmed and placed to gravity drainage. Dressings were then applied.
The patient was brought to the operating room, and placed in the supine position. General endotracheal anesthesia was then established. The abdomen was prepped and draped in standard fashion. A midline intraumbilical incision was made and carried through the subcutaneous tissue to the fascia at the base of the umbilicus. The fascia incised. Heavy Vicryl was placed on either side of the fascial defect. The 5mm trocar was entered through the defect into the abdomen. Pneumoperitoneum was established. The abdomen examined with laparoscope. There was no evidence of injury to the bowel secondary to port placement noted. A 5 mm left upper quadrant port was placed under direct vision. The endoscope was advanced into the mouth and introduced into esophagus. The scope was passed through the esophagus and gently insufflated as it entered the stomach. The stomach expanded appropriately. The laparoscopic needle was introduced into stomach through the LUQ port. The guidewire was advanced through the needle under endoscopic guidance. A endoscopic wire snare was used to grasp the guidewire. Once attachment was confirmed, the scope was withdrawn and the guidewire pulled through. The PEG introducer was placed over the guidewire. The wire was retracted and PEG introducer was advanced into the stomach and out through the port site. The guidewire was removed. The endoscope was re-introduced. The PEG tube was noted to be against the abdominal wall. The pneumoperitoneum was allowed to resolve and the remaining port removed. The previously placed Vicryl sutures through the fascial defect were then tied and there was no evidence of hernia noted. The skin was closed using running 4-0 subcuticular sutures. Steri-Strips and dressings were applied. The endoscope was removed and air aspirated from the stomach as it was withdrawn. The tube collar was advanced onto the skin and secured. The tube was trimmed and placed to gravity drainage. Dressings were then applied.