I'm being told to bill the following:
Laparoscopic Removal of Lap-Band 43774
and Removal of gastric pouch 43659
It was my understanding that the removal of the gastric pouch was included to the 43774.
Op Note:
Pt was admitted to the opeartive suite, placed under general anesthesia without complication The abdomen. A Handsbreadth below the left subocstal margin at the prvious port site. After insufflation liver retractin was placed a the epigastrium. The nathanson rettactor 5mm trocars were placed inthe upper abdomen under direct vision. The tubin had some gastrocolic omentium adherent to it. This was taken down with cautery and ligasure down to the band capsule. A capsulotomy was made until the clasp mechanism could be brought out and the band was transected The band was removed from iits capsule. The band was then cut in pieces, brought out a 10 mm torcar site until the band was removed in total. The capsule was incised veritically to remove the stricture, so that the capsule could be spread apart for 2 cm to clear pasage through intragastric ballon tube through the gastric pouch. Eviseal was placed in the band capsule tract and Floseal was placed along the dissection on the other side of the liver to ensure hemostasis. The tubing was then removed up to the connector and retraction was removed, abdomen was deflated. Dissection was then carried down to the port and the anterior capsule was removed. The port was removed from the anterior fascia along with its 2 sutrues and the remaing tubing. The wound was irriagted. The deep facia was closed with a figure-of-eight 0 Vicryl suture and the skin was closed subutioular 4-0 monocryl. The patient tolerated the procedure well and was discharged from the op suite in good condition.
Thanks!
Laparoscopic Removal of Lap-Band 43774
and Removal of gastric pouch 43659
It was my understanding that the removal of the gastric pouch was included to the 43774.
Op Note:
Pt was admitted to the opeartive suite, placed under general anesthesia without complication The abdomen. A Handsbreadth below the left subocstal margin at the prvious port site. After insufflation liver retractin was placed a the epigastrium. The nathanson rettactor 5mm trocars were placed inthe upper abdomen under direct vision. The tubin had some gastrocolic omentium adherent to it. This was taken down with cautery and ligasure down to the band capsule. A capsulotomy was made until the clasp mechanism could be brought out and the band was transected The band was removed from iits capsule. The band was then cut in pieces, brought out a 10 mm torcar site until the band was removed in total. The capsule was incised veritically to remove the stricture, so that the capsule could be spread apart for 2 cm to clear pasage through intragastric ballon tube through the gastric pouch. Eviseal was placed in the band capsule tract and Floseal was placed along the dissection on the other side of the liver to ensure hemostasis. The tubing was then removed up to the connector and retraction was removed, abdomen was deflated. Dissection was then carried down to the port and the anterior capsule was removed. The port was removed from the anterior fascia along with its 2 sutrues and the remaing tubing. The wound was irriagted. The deep facia was closed with a figure-of-eight 0 Vicryl suture and the skin was closed subutioular 4-0 monocryl. The patient tolerated the procedure well and was discharged from the op suite in good condition.
Thanks!