nlbarnes
Expert
Hi all! I believe I previously posted this however I haven't gotten any replies. I can REALLY use help please.
I have 43860 for the revision but that's open, not laparoscopic. Not sure if there's a 2nd code.
POSTOPERATIVE DIAGNOSIS:
Chronic marginal ulcer at gastrojejunal anastomosis following gastric bypass.
PROCEDURE:
Revision of gastrojejunostomy with excision of previous anastomosis.
DESCRIPTION OF PROCEDURE:
Through a small incision superior to the umbilicus, a 5-mm optical
view trocar was placed into the peritoneal cavity under direct
laparoscopic visualization.
12 mm
trocars were placed in the left upper quadrant and the left and right
mid abdomen under direct vision. The liver was retracted with a 5 mm
probe introduced at the subxiphoid level. The gastrojejunal
anastomosis was inspected was free of any adhesions to local
structures. The junction of the stomach and the jejunum was
inspected, and filmy adhesions between this area and the gastric
remnant were taken down with the Harmonic Scalpel. It was possible to
proceed posterior to the digastric pouch at the level of the
gastrojejunostomy separating this area completely from the gastric
remnant. The small bowel was free in the area of the Roux limb
leading up to the gastrojejunostomy. A 0.4 small bowel resection was
chosen near the anastomosis, and divided with a white cartridge staple
load. The stomach was divided above the gastrojejunal anastomosis in
an area with good blood supply, and clearly separate from the
ulcerated area. Two applications of a green cartridge were used for
this division. The tissue posterior to the ulcerated area was
inspected and it appeared that the posterior surface of the stomach
was beginning to perforate in this area posteriorly. The mesentery of
the short piece of small intestine to be resected was divided
110221116
I have 43860 for the revision but that's open, not laparoscopic. Not sure if there's a 2nd code.
POSTOPERATIVE DIAGNOSIS:
Chronic marginal ulcer at gastrojejunal anastomosis following gastric bypass.
PROCEDURE:
Revision of gastrojejunostomy with excision of previous anastomosis.
DESCRIPTION OF PROCEDURE:
Through a small incision superior to the umbilicus, a 5-mm optical
view trocar was placed into the peritoneal cavity under direct
laparoscopic visualization.
12 mm
trocars were placed in the left upper quadrant and the left and right
mid abdomen under direct vision. The liver was retracted with a 5 mm
probe introduced at the subxiphoid level. The gastrojejunal
anastomosis was inspected was free of any adhesions to local
structures. The junction of the stomach and the jejunum was
inspected, and filmy adhesions between this area and the gastric
remnant were taken down with the Harmonic Scalpel. It was possible to
proceed posterior to the digastric pouch at the level of the
gastrojejunostomy separating this area completely from the gastric
remnant. The small bowel was free in the area of the Roux limb
leading up to the gastrojejunostomy. A 0.4 small bowel resection was
chosen near the anastomosis, and divided with a white cartridge staple
load. The stomach was divided above the gastrojejunal anastomosis in
an area with good blood supply, and clearly separate from the
ulcerated area. Two applications of a green cartridge were used for
this division. The tissue posterior to the ulcerated area was
inspected and it appeared that the posterior surface of the stomach
was beginning to perforate in this area posteriorly. The mesentery of
the short piece of small intestine to be resected was divided
110221116