tci General Surgery Coding Alert - 2012 Issue 11

You Be the Coder: Multiple Codes Cover Duodenal Ulcer Case

Question: How should we code the following case for an open gastrojejunostomy with vagotomy, pyloroplasty, and bleeding duodenal ulcer repair? The op note follows: Identified the pylorus and followed distally, noting approximately 2 cm area of necrosis with perforation of the anterior superior duodenal wall just distal to the hepatoduodenal ligament where the bile duct and the duodenum meet. Performed a Kocher maneuver, and on manipulation, the necrotic area fell away. Opened the duodenum longitudinally through the pylorus and debrided the necrotic portion of the duodenal wall, noting a bleeding vessel at the base of the ulcer, which was...

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