Currently, cpt does not include a specific code to describe the laparoscopic version of this procedure. In 1994, when codes 49650 and 49651 were created, very few laparoscopic inguinal hernia repairs were performed for incarcerated hernias. Suture of the omentum to another organ to increase arterial circulation. Main outcome measures morbidity, operating time, analgesic requirements, length of hospital stay, and time to return to work. This patch is typically used for holes with a size of 5mm or less.
The management of large perforations of duodenal ulcers. A pedicle of omentum based on right omental artery is brought between these sutures and these sutures are tied again with pedicle of omentum between knots over the perforation figure 3. To assign the correct codes, experienced medical coders carefully examine the operative reports to determine what procedure or procedures the surgeon performed. The omentum is made up of the greater omentum which is an important storage for fat deposits and the lesser omentum which connects the stomach and intestines to the liver. Modified grahams repair for peptic ulcer perforation. Laparoscopy hospital how to do laparoscopic repair of. Therefore, cpt code 49320 is included in cpt codes 38120, 38570 38572, 43280, 4365143653, 4418044227, 44970, 4756247570, 4932149323, 4965049651, 5469054692, 55550, 5854558554, 58660 58673, and 60650. This video is a stepbystep approach to the technique of laparoscopic repair of perforated peptic ulcer with omental patch. Laparoscopic repair of duodenal perforation by graham patch plication is an excellent alternative approach. The operation was carried out on a 49 yr old male patient. Secondary outcomes assessed were mortality, operation time and hospital length. Frantzides was the first in the world to report a laparoscopic omental cerebellar pedicled graft in 2002.
Suture of the greater omentum to the abdominal wall to induce collateral portal circulation. Graham patch versus modified graham patch in the management of. Cpt code 49659, unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy is reported when a cpt code does not exist for the type of repair performed. Lap graham patch of duodenal ulcer general surgery.
Laparoscopic dissection of the adhesions between the omentum and the anterior abdominal wall a and mobilization of the omental flap using the left epiploic vessels b. Secondary outcomes assessed were mortality, operation time and hospital length of stay. Han ms, kim ww, oh jh 2005 results of laparoscopic sleeve gastrectomy lsg at 1 year in morbidly obese korean patients. Laparoscopic procedures on the abdomen, peritoneum, and omentum, surgery abdomen code laparoscopic laparoscopy list omental omentopexy omentum peritoneum primary procedure procedures separately surgery surgical tacking. At the time of the study, 7 patients had undergone a laparoscopic harvest of an omental flap for coverage of sternal and mediastinal wounds. An appropriatelysized tongue of tensionfree, wellvascularized omentum is used to plug the perforation. Laparoscopic omental patch closure of perforated duodenal ulcer has become increasingly common as the field of minimally invasive surgery. We present the case of a 64 year old female that presented to the emergency room with abdominal pain 9 days after an elective laparoscopic cholecystectomy.
The correct code to assign is 9030400 887 other repair of stomach for omental patch repair of an ulcer that is not bleeding. Actually, operative techniques for laparoscopic ulcer repair include grahamsteele patch repair, suture closure with an omental patch and simple closure without omental patch. We present, here, the technique and results of our laparoscopic simple onestitch suture with omental patch technique for treating 35 patients with perforated duodenal ulcer. Omental definition of omental by medical dictionary.
Laparoscopic mobilization of an omental flap for a chronic. Management of acute bleeding post laparoscopic sleeve gastrectomy. According to the operative report, the omentoplasty was performed after placing lembert sutures of 30 silk. Pdf laparoscopic suture repair of a perforated gastric. Once irrigation was complete, a large volume of omentum was. A graham patch defines a surgical procedure to close an opening in the duodenum caused by a peptic ulcer. Followup gastroscopy was performed after an eightweek course of. Laparoscopic repair for perforated peptic ulcers with uclip. Silk sutures are passed between edges of perforation and tied to close the perforation figure 2. Duodenal ulcer perforations are a common cause of peritonitis. In researching cpt code 49905 omental flap, intraabdominal list separately in addition to code for primary procedure, i found an article in aapc. Nov 20, 2007 we present, here, the technique and results of our laparoscopic simple onestitch suture with omental patch technique for treating 35 patients with perforated duodenal ulcer. An omental j flap provides 1 a nonirradiated vascular pedicle flap to cover. A graham patch is a surgical technique that is used to close duodenal perforations.
Laparoscopic surgery cpt codes 49320, 58661 medicare. Current procedural terminology gastrorrhaphy, suture of. The stitch was left open, and a tongue of omentum was then placed over the ulcer and tied down with stitches. Patients comprised 4 males and 3 females with an average age of 65. Unlisted cpt 44238 represents a laparoscopic exclusion of small bowel from pelvis with an omental pedicle flap. Laparoscopic harvest of an omental flap to reconstruct an. From december 1992 to february 1994, laparoscopic omental patch repair followed by use of h2antagonists was performed successfully in 11. The open hernia repair codes are found in the range of codes 4949149611.
After laparoscopic repair was first introduced for duodenal ulcer perforation, many. Omentopexy definition of omentopexy by medical dictionary. Oct 24, 2005 threestitch laparoscopic graham patch repair lgpr for perforated duodenal ulcer enjoyed the same advantage as open graham patch repair. Research from jama facial plastic surgery gastroomental free flap reconstruction of the head and neck. The 1994 cpt code set added only two codes for laparoscopic hernia repair 49650 and 49651. However, it was not a popular approach because it had problems of suture entanglement and difficult laparoscopic suturing and knotting. Laparoscopic omental patch cpt code keyword after analyzing the system lists the list of keywords related and the list of websites with related content, in addition you can see which keywords most interested customers on the this website.
To view all forums, post or create a new thread, you must be an aapc member. Or is the intent of the code, reconstruction of a defect only. A large variety of woodworking plans video upper gi endoscopy cpt code of laparoscopic repair of perforated peptic ulcer with omental patch the operation introduction. The laparoscopic codes are found in the cpt range of codes, 4965049657. The procedure is relatively simple but require the ability to perform an intracorporeal knot. Hypothesis laparoscopic management of perforated duodenal ulcers is safe and effective design prospective nonrandomized controlled trial setting tertiary care academic center patients and methods between october 1993 and october 1997, 30 patients underwent laparoscopic graham patch repair of perforated duodenal ulcers and 16 had an open repair. Laparoscopic minimally invasive repair for perforated. The laparoscopic treatment included peritoneal lavage, suture of the perforation without knotting, and then tying the suture over the omentum. An open code may not be used if a procedure is done laparoscopically. A retrospective analysis was performed for 80 out of 1500 patients, who underwent laparoscopic sleeve gastrectomy lsg in.
The classic, pedicled omental patch that is performed for the plugging of these perforations was first described by cellanjones in 1929, although it is commonly, and wrongly attributed to graham, who described the use of a free graft of the omentum to repair the perforation in 1937. Coverage of the femoral vessels and the bovine pericardium patch with the omentum c, d figure 3. Bariatric procedures are widely spreading nowadays, laparoscopic sleeve gastrectomy is one of the most commonly performed bariatric operations, postoperative bleeding is being a serious and a common event of this operation. Laparoscopic omental patch repair of peptic ulcer perforation. Laparoscopic repair of duodenal perforation is a useful method for reducing hospital stay, complications and return to normal activity.
All surgical laparoscopic, hysteroscopic or peritoneoscopic procedures include diagnostic procedures. Laparoscopic primary repair with omentopexy for duodenal ulcer. The key points of the laparoscopic technique are 1 the coloepiploic detachment, 2 the section of the anastomotic arterial branches between the barkows arcade and the gastroepiploic arcade, 3 the mobilization of the greater omentum pedicled on the right gastroepiploic artery, and 4 its transposition into the mediastinum, taking care to. Laparoscopic surgery, when optimized by a simple repair without an omental patch and 10 mm of a largechannel aspiratorirrigator, may be safely and effectively applied to the patients with small. Four patients had diabetes, and 4 had chronic obstructive pulmonary disease copd. Peritonitis due to peptic ulcer perforation is a surgical emergency with a high risk of mortality and morbidity. Surgical oasis institute dr iraniha robotic surgery 1,516 views 6. A graham patch refers to a surgical procedure to close the duodenum opening caused by a peptic ulcer. Omental patch or graham patch closure of perforated duodenal ulcers was first described in 1929 by cellenjones and by graham in 1937. Graham patch repair of duodenal ulcer medical coding. Omental harvest for complex poststernotomy mediastinal wounds has traditionally required a formal laparotomy in often highrisk patients, thus making it the procedure of last resort. Lap graham patch of duodenal ulcer general surgery coding. General surgery discussion list participant answer. May 08, 2020 the graham patch technique might be performed via laparoscopic surgery, which may prove as successful as opening the abdomen, but generally produces a quicker recovery.
Laparoscopic repair of perforated duodenal ulcer with. Laparoscopic hernia repair was developed as a technique long after open hernia repair. Laparoscopic repair for perforated peptic ulcers with u. John h rodriguez, md, diya alaedeen, md fairview hospital laparoscopy has played an important role in the management of complications of peptic ulcer disease.
The primary outcomes assessed were septic abdominal and extraabdominal complications. The technique is named after a canadian doctor who successfully used a flap of skin inside the abdominal cavity to repair perforated ulcers. Perforated ulcer disease opportunities for improving outcome. In this case, the nerve block is not reported separately and is included in the surgical procedure.
A prospective series from january 2000 to september. In perforated peptic ulcer disease, laparoscopic omental patch repair offers a number of advantages. Modified graham patch repair in perforated duodenal ulcer. If youve forgotten your username or password use our password reminder tool. More recently, this technique has been performed using a laparoscopic approach. Setting department of surgery, moi grahams omental patch and copious irrigation of a proximal gastric vagotomy or taylor procedure laparoscopic repair of duodenal ulcer perforation is as peptic ulcer is the most common cause of ugib. The national center for biomedical ontology was founded as one of the national centers for biomedical computing, supported by the nhgri, the nhlbi, and the nih common fund under grant u54hg004028.
Cpt code 49905 surgical procedures on the omental flap. Sutureless onlay omental patch for the laparoscopic repair of perforated peptic ulcers. Subscribe to aapc coder and get the code details in a flash. All usergenerated information on this site is the opinion of its author only and is not a substitute for medical advice or. Coding colectomy key considerations for claim submission. Once the physician finds the damaged section of intestine, he or she threads pieces of suture material through each end of the opening. Can addon code 49905 omental flap be reported for buttressing an incision or anastomosis. Pdf a comparison of laparoscopic and open repair of. Laparoscopic way of dealing the perforated peptic ulcer is now frequently performed in areas of expertise worldwide. Both laparoscopic and open repairs were made with an omentum patch or fibrin sealant.
Cpt code surgical procedures on the abdomen, peritoneum. Laparoscopic harvest of omental flaps for reconstruction. Wa coding rule 111203 omental patch for peptic ulcer wa health. Graham patch for duodenal ulcer medical billing and. Mortality and morbidity remain high and laparoscopic omental patch repair was. The first successful laparoscopic suture repair for perforated peptic ulcer was described by nathanson et al. Laparoscopic suture repair of a perforated gastric ulcer in a severely cirrhotic patient with portal hyper tension. In this case, use code 43659, unlisted laparoscopic procedure, stomach. The current procedural terminology cpt code 49905 as maintained by american medical association, is a medical procedural code under the range surgical procedures on the omental flap. Even though its nearer to cpt 43840, still you should not code it. Laparoscopic harvest of omental flaps for reconstruction of. The omentum is a membranous double layer of fatty tissue that covers and supports the intestines and organs in the lower abdominal area.
Muhammad shahzad, doc holy family hospital, rawalpindi, pakistan introduction. In some cases, the graham patch closes the perforation in an emergency situation, with peritonitis treated afterward with medication. A the graham patch uses sutures placed on either side of the perforation with the addition of the omentum. A piece of omentum is used to cover the perforation. A prospective series from january 2000 to september 2004 was. The doctor creates the omental flap and sutures it to the site of the duodenal ulcerwound to repair it. If you are a member and have already registered for member area and forum access, you can log in by clicking here. As there is no specific cpt for graham patch operation in the current cpt manual, you should bill. Soon after that, the laparoscopic approach became a widespread procedure. The decision making for laparoscopic surgery for the patient presenting with peritonitis is. Modified grahams repair for peptic ulcer perforation international. Two authors have described laparoscopic repair, with interposition of peritoneum 6 or an omental patch 3 with good results. The surgeon uses sutures to secure the patch and close the perforation.
Comparative studies between these different techniques of interposition are not available, neither with laparotomy nor with laparoscopy. As compared to open laparotomy pedicled omentum repair, the laparoscopic omental patch closure in selected patients has short hospital stay. Jul 29, 2009 actually, operative techniques for laparoscopic ulcer repair include grahamsteele patch repair, suture closure with an omental patch and simple closure without omental patch. There is no current cpt code laparoscopic pyloroplasty, only an open code. Because no upper abdominal incision is made, there is decreased postoperative pain, and the patient rapidly recovers with fewer and less severe complications. Laparoscopic omental patch repair for perforated peptic ulcer. Mar 18, 2020 the open hernia repair codes are found in the range of codes 4949149611. The graham patch technique can be performed during laparoscopic surgery. Hernia repair and complex abdominal wall reconstruction. Called the omentum, this piece of fatty tissue hangs from the stomach and drapes into the abdomen, covering the intestines. Hernia repair code it right to maximize reimbursement. The current procedural terminology cpt code range for surgical procedures on the abdomen, peritoneum, and omentum 4900049999 is a medical code set maintained by the american medical association.