jdibble
True Blue
Our surgeon took his patient back to surgery to do a revision of a fundoplication. He removed some stitches to allow the fundoplication to open and did a dilation of the esophagus. I have CPT code 43450 for the dilation but I have no idea how to code the stitch removal. The OP note is below. If anyone has any ideas on how to code this it would be appreciated!!
Preoperative Diagnosis
Dysphagia after partial fundoplication
Postoperative Diagnosis
Same
Procedure Performed
Laparoscopy, revision of partial fundoplication, upper endoscopy and sizing of esophagus with bougie dilators.
The patient was taken the operating room after induction satisfactory general endotracheal anesthesia was prepped draped in usual fashion spine position in the low lithotomy position. His previous laparoscopy incisions were opened and trocars placed after insufflating the abdomen with a Veress needle. Exploratory laparoscopy was performed. There was inflammation around the hiatus which was expected and perhaps more so than expected. The left lobe of the liver was carefully dissected off of the anterior portion of the repair and swept laterally with the liver retractor. Dissection of some surrounding fat and omentum was performed through very dense adhesions. This was stripped inferiorly exposing the partial fundoplication. The right and left aspects of the fundoplication were identified. At this point a orogastric tube was inserted to clearly identify the esophagus. This was noted in the stomach. Several sutures that were nearly absorbed in scar and inflammatory tissue were identified and elevated. Each of these on the left side of the fundoplication were cut and removed allowing the fundoplication to open. At this point upper endoscopy was performed and a wire from the Savary dilator set was placed in the stomach under direct visualization. This was then sized from 11 to 16 mm (48 French with no resistance under visualization during laparoscopy. Repeat endoscopy revealed that the area the fundoplication was not as tight and the scope passed easily into the stomach. Air was aspirated from the stomach in the esophagus and the endoscope removed. The abdomen was irrigated aspirated and desufflated after removing the trocars under direct visualization. Three 0 Vicryl sutures were used to close the subcutaneous tissues and Steri-Strips and sterile bandages were applied. The patient tolerated this procedure satisfactorily and returned to recovery in stable condition with all final sponge, instrument and needle counts correct.
Thank you for all answers!!
Jodi
Preoperative Diagnosis
Dysphagia after partial fundoplication
Postoperative Diagnosis
Same
Procedure Performed
Laparoscopy, revision of partial fundoplication, upper endoscopy and sizing of esophagus with bougie dilators.
The patient was taken the operating room after induction satisfactory general endotracheal anesthesia was prepped draped in usual fashion spine position in the low lithotomy position. His previous laparoscopy incisions were opened and trocars placed after insufflating the abdomen with a Veress needle. Exploratory laparoscopy was performed. There was inflammation around the hiatus which was expected and perhaps more so than expected. The left lobe of the liver was carefully dissected off of the anterior portion of the repair and swept laterally with the liver retractor. Dissection of some surrounding fat and omentum was performed through very dense adhesions. This was stripped inferiorly exposing the partial fundoplication. The right and left aspects of the fundoplication were identified. At this point a orogastric tube was inserted to clearly identify the esophagus. This was noted in the stomach. Several sutures that were nearly absorbed in scar and inflammatory tissue were identified and elevated. Each of these on the left side of the fundoplication were cut and removed allowing the fundoplication to open. At this point upper endoscopy was performed and a wire from the Savary dilator set was placed in the stomach under direct visualization. This was then sized from 11 to 16 mm (48 French with no resistance under visualization during laparoscopy. Repeat endoscopy revealed that the area the fundoplication was not as tight and the scope passed easily into the stomach. Air was aspirated from the stomach in the esophagus and the endoscope removed. The abdomen was irrigated aspirated and desufflated after removing the trocars under direct visualization. Three 0 Vicryl sutures were used to close the subcutaneous tissues and Steri-Strips and sterile bandages were applied. The patient tolerated this procedure satisfactorily and returned to recovery in stable condition with all final sponge, instrument and needle counts correct.
Thank you for all answers!!
Jodi
