Question

7.12. The patient is a 56-year-old male who was admitted with a history of hematemesis for the past 36 hours. He also had some tarry black stools and was noted to have a giant gastric ulcer which was actively bleeding. Patient was subsequently referred for surgical intervention.

Final Diagnosis: 1. Acute gastric ulcer
2. Chronic pancreatitis
3. Liver cirrhosis due to alcoholism
4. Cirrhosis due to chronic hepatitis C
Procedure Performed: Subtotal gastrectomy with Billroth II anastomosis
Operative Procedure: The patient was brought to the operating room and placed on the table in a supine position, at which time general anesthesia was administered without difficulty. His abdomen was then prepped and draped in the usual sterile fashion. An upper midline incision was made. The peritoneum was then entered using the Metzenbaum scissors and hemostats. A retractor was placed, and he was noted to have a cirrhotic liver with micronodular cirrhosis. The left lobe of the liver was mobilized at that point, and the retractors were placed. On palpation of the stomach along the lesset curvature at approximately the mid portion, there was a large gastric ulcer located in the body of the stomach. At this point, the gastrocolic omentum was taken off the greater curvature of the stomach tothe level just above the pylorus. Additionally, the lesser omentum was taken down off the lesser curvature of the stomach to the level of the pylorus The body of the stomach was then transected approximately 3 cm above the ulcer. At that point, the stomach was reconstructed in a Billroth ll fashion by brining the jejunum through the transverse colon mesentery. Two stay sutures were placed to align the Jejunum along the posterior wall of the stomach, and a GIA stapler was used to create the anastomosis without difficulty. The stomach and jejunum were then pulled below the transverse colon mesentery, and this was tacked in several places using 3-0 silk sutures. A feeding jejunostomy tube was then placed distal to this using the feeding Jejunostomy kit without difficulty. The abdomen was then irrigated thoroughly USIng normal saline solution. Hemostasis was achieved using Bovie electrocautery. The midllne Incision was then closed using #1 PDS in a running fashion. the skin was closed using skin staples. A sterile dressing was applied. The pateint was extubated in the operating room and returned to the intensive Care Unit in gaurded condition.

Code Assignment Including POA Indicator

lCD-10-CM Principal Diagnosis Code(s):

lCD—10-CM Additional Diagnoses Code(s):

lCD-10-PCS Principal Procedure Code(s): ____________________________

Additional Procedures Code(s): _____________________
Optional MS-DRG Exercise (for users with access to MS-DRG software or tables)

Which MS_DRG is appropriate OF this case?
Excluding the principal diagnosis, what other code affects the MS-DRG assignment for this admission?

Need help with all codes and MS-DRG codes.

Answer 1

.code437: partial gastrectomy with anastomoses to jejunum

GEM Conversion to ICD-10 PCS

Fs: 10112 – Bypass Stomach to Jejunum, Open Approach

0D1.64ZA

Fs: 10112 – Bypass Stomach to Jejunum, Percutaneous Endoscopic Approach

0D1.68ZA

Fs: 10112 – Bypass Stomach to Jejunum, Via Natural or Artificial Opening Endoscopic

0DB.60ZZ

Fs: 10111 – Excision of Stomach, Open Approach

0DB.63ZZ

Fs: 10111 – Excision of Stomach, Percutaneous Approach

0DB.64ZZ

Fs: 10111 – Excision of Stomach, Percutaneous Endoscopic Approach

0DB.67ZZ

Fs: 10111 – Excision of Stomach, Via Natural or Artificial Opening

0DB.68ZZ

Fs: 10111 – Excision of Stomach, Via Natural or Artificial Opening Endoscopic

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