As there is no specific cpt for graham patch operation in the current cpt manual, you should bill. In such an event, the endoscopic repair is less invasive and its performance has been reported in several cases. With the discovery of helicobacter pylori hp and advances in ulcer medications, omental patch repair for the ppu, followed by eradication of hp and the administration of proton pump inhibitors. It has not only allowed identifying the site and pathology of perforation, but also allowed closure of the perforation with better peritoneal lavage than in the open repair. After perforation of duodenal ulcer, only treatment is its immediate surgical repair. This patch is typically used for holes with a size of 5mm or less. Consider using the repair root operation to classify the transplantation of an omental flap to a specific body part. The current treatment of perforated peptic ulcer is primary closure, covered by omentoplasty. Laparoscopic omental patch repair for perforated peptic ulcer. A graham patch is a surgical technique that is used to close duodenal perforations.
Laparoscopic repair of perforated duodenal ulcer series of. 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. Laparoscopic repair of peptic ulcer perforation without omental patch versus conventional open repair. Routine laparoscopic singlestitch omental patch repair for. Graham patch for duodenal ulcer medical billing and coding. Modalities of treatment carried out in these instances are free omental plug, jejunal serosal patch, tube duodenostomy, pyloric exclusion with. Main outcome measures morbidity, operating time, analgesic requirements, length of hospital stay, and time to return to work. Current procedural terminology gastrorrhaphy, suture of. Proper repair of a perforated peptic ulcer is extremely important. Original article graham patch vs modified graham patch in. This need cpt code for graham patch procedure page on empowher womens health works best with javascript enabled in your browser. The operation was carried out on a 49 yr old male patient. Clinical advice supports a different code be used for omental patch for an ulcer that is perforated but not bleeding.
Decision omental patch for repair of bleeding gastric ulcer is coded to 3050500 874 control of bleeding peptic ulcer. Laparoscopy hospital how to do laparoscopic repair of. Diagnosis and treatment of perforated or bleeding peptic. Western australian coding rule 111203 omental patch for peptic ulcer q. The operation report states suture of perforated peptic ulcer, omental patch fixed operation report attached. Graham patch vs modified graham patch in management of perforated peptic ulcer 29 int j res med.
B for lap also, you should go for unlisted 43659 and should compare with cpt 43840. Modified grahams repair for peptic ulcer perforation international. Laparoscopic omental patch repair lopr of perforated peptic ulcer ppu was introduced two decades ago. Laparoscopic minimally invasive repair for perforated. A the graham patch uses sutures placed on either side of the perforation with the addition of the omentum.
Actually, operative techniques for laparoscopic ulcer repair include grahamsteele patch repair, suture closure with an omental patch and simple closure without omental patch. The aim of this study was to compare the outcomes between laparoscopic and open omental patch repair lopr versus or in patients with similar presentation of perforated peptic ulcer ppu. Classically, this complication has required anastomotic revision, however, this approach is associated with significant morbidity. Patients were identified by icd9 billing information. Another possible code would be suture, ulcer, perforated duodenal gastric 3037510 887. Laparoscopic repair of perforated peptic ulcer groups 1 and 2 took significantly longer than open repair groups 3 and 4.
Because no upper abdominal incision is made, there is decreased postoperative pain, and the patient rapidly recovers with fewer and less severe complications. Feasibility of notes omental plug repair of perforated. Several small series have suggested that abdominal washout with omental patch repair may be utilized in select cases. Western australian coding rule department of health. Lap graham patch of duodenal ulcer general surgery. Both laparoscopic and open repairs were made with an omentum patch or fibrin sealant. Sep 25, 2019 a patch of omentum is brought without tension and positioned over the perforation, and the sutures are successively tied from the superior to the inferior aspect across the omental patch to anchor the omental graft in place see the images below final repair as seen from anterior with omentum secured in place on to the defect itself. Called the omentum, this piece of fatty tissue hangs from the stomach and drapes into the abdomen, covering the intestines. Repair of perforated ulcer department of health, victoria. Laparoscopic omental patch for perforated peptic ulcer avi. Laparoscopic repair of perforated peptic ulcers versus. Laparoscopic omental patch closure lopc has been performed in 7 patients of perforated duodenal ulcer in a period from january 1993 to the end of december 1994.
Laparoscopic omental patch repair of peptic ulcer perforation. The laparoscopic treatment included peritoneal lavage, suture of the perforation without knotting, and then tying the suture over the omentum. An omental flap is a segment of omentum, with its supplying blood vessels, transplanted either with an intact pedicle or as a free tissue to a distant area and revascularized by arterial and venous anastomoses. What is the correct code to assign for omental patch for repair of bleeding gastric ulcer. Primary repair of duodenal perforations with the omental patch technique has re emerged as the mainstay of treatment of this widelyprevalent condition. Comparison of closure of gastric perforation ulcers with. The doctor creates the omental flap and sutures it to the site of the duodenal ulcer wound to repair it. May 08, 2020 a graham patch defines a surgical procedure to close an opening in the duodenum caused by a peptic ulcer. Duodenal ulcer perforations are a common cause of peritonitis. Laparoscopic graham patch repair of a perforated marginal ulcer 6 yrs after rygb duration. Even though its nearer to cpt 43840, still you should not code it. The earliest prospective studies from asia successfully demonstrated the safety and feasibility of laparoscopic repair 1, 2. Rr graham, the treatment of perforated duodenal ulcers, surg gynec obstet 64 1937, pp.
Called the omentum, this piece of fatty tissue hangs from the stomach and drapes into the abdomen. Lap graham patch of duodenal ulcer general surgery coding. Original article graham patch vs modified graham patch. Omental patch repair has also been incorporated in the management of perforated gastric ulcers. Graham patch repair of duodenal ulcer medical coding. Giant defects, as in this case, cannot be closed by simple primary closure. According to the operative report, the omentoplasty was performed after placing lembert sutures of 30 silk. On the other hand, the idea of using an omental patch for such repairs has been applied for a long time to the surgical treatment of gastroduodenal ulcer perforation. The current procedural terminology cpt code range for repair procedures on the abdomen, peritoneum, and omentum 4949149659 is a medical code set maintained by the american medical association. Three or four sutures are used preferably of nonabsorbable material. Omental patch or graham patch closure of perforated duodenal ulcers was first described in 1929 by cellenjones and by graham in 1937.
Laparoscopic repair of perforted duodenal ulcer has many advantages as less. Omental graham patch repair is the treatment of choice for acute duodenal or gastric perforations. Followup gastroscopy was performed after an eightweek course of. Generalized peritonitis requiring reoperation after leakage of omental patch repair of perforated peptic ulcer. Pdf a comparison of laparoscopic and open repair of. An updated metaanalysis of laparoscopic versus open repair. Muhammad shahzad, doc holy family hospital, rawalpindi, pakistan introduction. In perforated peptic ulcer disease, laparoscopic omental patch repair offers a number of advantages.
The doctor creates the omental flap and sutures it to the site of the duodenal ulcerwound to repair it. 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. This video is a stepbystep approach to the technique of laparoscopic repair of perforated peptic ulcer with omental patch. However in researching this denial, i came across several coders that do not agree with using 49905 and instead suggested using an unlisted code for the entire procedure or using 43840 with an unlisted code for the graham patch. More recently, this technique has been performed using a laparoscopic approach. Or is the intent of the code, reconstruction of a defect only. Song ky, kim th, kim sn, park ch 2008 laparoscopic repair of perforated duodenal ulcers. Repair of duodenal perforation by graham patch plication as was described in 1937 represents an excellent alternative approach. The classical graham patch technique, described by cellanjones in 1929 and in 1937 by graham can be applied. Laparoscopic repair of duodenal perforation by graham patch plication is an excellent alternative approach. Subscribe to aapc coder and get the code details in a flash. The decision making for laparoscopic surgery for the patient presenting with peritonitis is.
A patient is 62year old man presented with an acute abdomen. A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique. Laparoscopic repair for perforated peptic ulcers with uclip. The primary outcomes assessed were septic abdominal and extraabdominal complications. Jun 25, 2005 duodenal ulcer perforations are a common cause of peritonitis. A piece of omentum is used to cover the perforation.
The traditional management of perforated duodenal ulcer was graham patch plication described in 1937. These trials included patients with clinical suspicion of perforated peptic ulcer that was confirmed at surgery. Laparoscopic way of dealing the perforated peptic ulcer is now frequently performed in areas of expertise worldwide. Laparoscopic versus open omental patch repair for early. Cpt code repair procedures on the abdomen, peritoneum, and. What is the correct code for a graham patch omentoplasty used to repair a perforated duodenal ulcer. The current advice at our organisation is to code as repair of site being patched.
Modified grahams repair for peptic ulcer perforation. 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. Laparoscopic omental patch repair for perforated ulcers has been shown to be a feasible and safe procedure in selected patients. Though early results were impressive, they were hampered by various shortcomings including selection bias only. Management of perforated gastric and duodenal ulcers. The surgeon uses sutures to secure the patch and close the perforation. A graham patch defines a surgical procedure to close an opening in the duodenum caused by a peptic ulcer.
The the patients with duodenal perforation who present with unstable haemodynamics and gross peritoneal contamination the safest surgery, is a simple closure with a grahams patch using omentum. Best answers yes, i use both 43840 and addon 49905. Omental patch repair effectively treats perforated marginal. Smoking, nsaid, and steroid use have been associated with increased risk of marginal ulcer formation. 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. The procedure is relatively simple but require the ability to perform an intracorporeal knot. A prospective study nitin agarwal1, arun gupta2, bk jain2 and ram niwas saran3 1department of surgery, renal transplant unit, postgraduate institute of medical education and research pgimer and.
An appropriatelysized tongue of tensionfree, wellvascularized omentum is used to plug the perforation. Oct 01, 2015 2020 icd10pcs procedure code 0dq64zz repair stomach, percutaneous endoscopic approach. Laparoscopic repair for perforated duodenal ulcer was first described in 19903. Laparoscopic omental patch closure of perforated duodenal ulcer has become increasingly common as the field of minimally invasive surgery. Perforated ulcer disease opportunities for improving outcome. 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. Can addon code 49905 omental flap be reported for buttressing an incision or anastomosis. The stitch was left open, and a tongue of omentum was then placed over the ulcer and tied down with stitches. A patch of omentum is brought without tension and positioned over the perforation, and the sutures are successively tied from the superior to the inferior aspect across the omental patch to anchor the omental graft in place see the images below final repair as seen from anterior with omentum secured in place on to the defect itself. The management of large perforations of duodenal ulcers bmc. Omental patch repair for duodenal ulcer perforation analysis of factors affecting outcome.
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