Coding, Classification and Reimbursement

how to code this procedure/ICD 10 PCS

  • 1.  how to code this procedure/ICD 10 PCS

    Posted 9 days ago
    ​​we are trying to figure out the pcs codes for this procedure.  Any help would be apprieciated

     

    FINDINGS: The risks, benefits, and alternatives were extensively discussed

    with the patient. Patient elects to proceed and written and verbal consent

    was obtained. Extensive discussion was performed with the patient  

    related to pain, infection, bleeding, local anatomical injury, effects of

    contrast on renal function, myocardial infarction, stroke, and death.

    Consent was obtained for all the above to include off label use of devices.

    Time-out was obtained. Maximum barrier technique was used including caps,

    masks, sterile gowns, sterile gloves, a large sterile sheet, hand hygiene,

    and 2% chlorhexidine percutaneous antisepsis.

     

    With the patient in a right decubitus position, a scout radiograph was

    obtained. Through the existing catheter after sterile prep and drape, a 5

    French Berenstein catheter and stiff angled glide wire were used in attempt

    to recanalize the tract. Dilute contrast was injected not clearly

    demonstrating the tract. With the catheter and wire positioned near the

    abdominal wall musculature, where eventually was used to recanalize the

    tract into the lumen of the stomach. Dilute contrast was injected to

    confirm the appropriate positioning within the lumen of the stomach. The

    wire was exchanged for an Amplatz wire. A 12 French Boston

    Scientific/MediTech locking all-purpose drainage catheter was advanced into

    the stomach to help support the tortuous tract with the metal cannula. An

    Amplatz wire was advanced over a catheter to the antrum of the stomach.

    Multiple attempts to advance a new cast jejunostomy tube 16 French failed.

    Subsequently, tract dilatation with a 7 mm x 40 mm mustang balloon was

    performed throughout the entire length of the tract. Through the

    gastrojejunostomy that was trimmed shorter multiple times, eventually using

    a long 7 French destination sheath with its introducer inside the

    gastrojejunostomy tube, were able to advance it in the stomach. Ultimately,

    the native gastrojejunostomy 16 French catheter was trimmed 20 cm shorter

    with the distal 5 cm custom side holes added. The balloon was inflated with

    10 mL of sterile water. The catheter was retracted to the anterior gastric

    wall with the disc placed flushed with the skin. Dilute contrast was

    injected through the catheter demonstrating appropriate position within the

    stomach.

     

    IMPRESSION:

    1. Successful replacement with a modified 16 French gastrojejunostomy tube

    from 20 cm shorter with new 5 cm of custom sidehole at the distal aspect.

    The balloon is inflated with 10 mL of sterile water, which will hopefully

    prevent dislodgment. Although the infusion will occur always from the

    abdominal wall with this modified technique. With the stomach is

    decompressing, the tip of the catheter will hopefully migrate towards the

    antrum of the stomach.

    2. The catheter may be used immediately.


    Thank you for your help

    Pat

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    Pat Geurts
    coding
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