ellis3350
Guru
I have a patient that less than a month ago underwent a very difficult and lengthy Ivor Lewis Esophagectomy for cancer. It was discovered that the patient now has an anastomotic leak based upon bilious drainage from his right chest tube.
Esophagoscopy scope was inserted into his posterior
oropharynx and I was able to advance this into a cervical esophagus. I
passed this down to approximately 31 cm from the incisors where I came
upon the esophageal anastomosis. Prior to this, there were no
significant findings of note on exam. When I did reach the esophageal
anastomosis, however, I was able to find some tissue sloughing and
fibrinopurulent tissue present. Further, on close exam, I was able to
find a small area of separation and what appeared to be evidence of one
of the chest tubes present. This was despite the tissue itself
appearing overall fairly healthy. It was friable with obvious healthy bleeding present.
No necrosis was noted. After examining the defect
present, I did elect to remove the Blake drain as it appeared to be
interfering with the possible closure of the esophageal defect. I then
went ahead and began preparing to perform placement of an endoluminal
VAC therapy. I then took a black VAC sponge and cut this to size based
upon the defect I visualized endoscopically. I then cut out a central
channel which allowed placement of an NG tube into this channel. I
passed the NG from the nose out through the mouth. The sponge was then
affixed to the NG tube. I then secured this with 2-0 Prolene sutures
and left a loop, which I then used the esophagoscopy scope to advance
the cushion into where the defect was located. I was able to
satisfactorily place this within the esophageal lumen at the site of the
defect. We then hooked the NG tube to suction and saw that the
esophagus closed quickly. It appeared to be functioning well. At this
point, the esophagoscopy scope was removed and this portion of the
procedure was terminated.
Has anyone ever coded an E-VAC before and if so... what CPT code have you used?
Thanks!!!
Esophagoscopy scope was inserted into his posterior
oropharynx and I was able to advance this into a cervical esophagus. I
passed this down to approximately 31 cm from the incisors where I came
upon the esophageal anastomosis. Prior to this, there were no
significant findings of note on exam. When I did reach the esophageal
anastomosis, however, I was able to find some tissue sloughing and
fibrinopurulent tissue present. Further, on close exam, I was able to
find a small area of separation and what appeared to be evidence of one
of the chest tubes present. This was despite the tissue itself
appearing overall fairly healthy. It was friable with obvious healthy bleeding present.
No necrosis was noted. After examining the defect
present, I did elect to remove the Blake drain as it appeared to be
interfering with the possible closure of the esophageal defect. I then
went ahead and began preparing to perform placement of an endoluminal
VAC therapy. I then took a black VAC sponge and cut this to size based
upon the defect I visualized endoscopically. I then cut out a central
channel which allowed placement of an NG tube into this channel. I
passed the NG from the nose out through the mouth. The sponge was then
affixed to the NG tube. I then secured this with 2-0 Prolene sutures
and left a loop, which I then used the esophagoscopy scope to advance
the cushion into where the defect was located. I was able to
satisfactorily place this within the esophageal lumen at the site of the
defect. We then hooked the NG tube to suction and saw that the
esophagus closed quickly. It appeared to be functioning well. At this
point, the esophagoscopy scope was removed and this portion of the
procedure was terminated.
Has anyone ever coded an E-VAC before and if so... what CPT code have you used?
Thanks!!!
