laparoscopic cholecystostomy tube placement cpt code

The gallbladder fluid will drain outside your body into a collection bag. Unauthorized use of these marks is strictly prohibited. 0000287453 00000 n As the patient was septic and high risk for cardiac complications, he underwent placement of percutaneous cholecystostomy tube by IR. 530.21 Ulcer of Esophagus with bleeding (ICD 9) ICD-10 Code K22.2 Esophageal Obstruction. Heres a rundown of how to apply the new codes. 0000006160 00000 n Save my name, email, and website in this browser for the next time I comment. Best answers. K91.5 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Following are some of the risk factors associated with conversion to open surgery: acute cholecystitis, male patients, morbid obesity, extensive upper adhesions due to prior surgeries or trauma. 51.01 is a specific code and is valid to identify a procedure. The .gov means its official. AHRQ QI ICD9CM and ICD10CM/PCS 4Specification Enhanced Version 5.0 Tower 1, Capital Square, Vci t 76. 47533 describes the initial placement of a percutaneous external biliary drainage catheter via a new access, and includes diagnostic imaging 47532. 0000081210 00000 n Patient underwent simple incision of the lingual frenum to free the tongue. Primary closure versus T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis of randomized clinical trials. if you have Dr. Z's interventional book, it tells you to use abcess codes 49424,76080,49423 & 75984 for tube check and change of cholecystostomy tube if the the tube was originally placed for infection drainage. Surgical procedures StatisticsThe goal of the surgical cross-over exhibits was to identify total volume, spending, price per procedure, and differences in cost across settings of care for procedures that can be performed either in hospital inpatient or hospital outpatient settings. The patient has a known filling defect in the region of the distal common bile duct, and is here for biopsy. 0000291427 00000 n 2021 Dec;101(6):1053-1065. doi: 10.1016/j.suc.2021.06.004. Laparoscopic cholecystectomy is the best treatment for acute calculus cholecystitis and the procedure should ideally be performed within 72 hours. Disclaimer. Example: A patient with an existing external biliary catheter presents for conversion to an internalized metallic biliary stent (47538). 1991 Mar;78(3):153-7 The drainage tube will be connected to a collection bag which can be periodically emptied. 0000287887 00000 n Trocar Cholecystostomy. 0000007656 00000 n Additionally, CPT code 47563 was reviewed in October 2010. 0000013436 00000 n Example: The patient has an internal/external catheter in place via a left anterior duct approach. Right hip pain ICD 10 coding is made easier with our billing guidelines. 0000008395 00000 n The physician is requested to remove the obstructed gastrostomy catheter and replace it. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 0000284942 00000 n CPT Code 47490, Surgical Procedures on the Biliary Tract, Introduction Procedures on the Biliary Tract - Codify by AAPC . Appreciate any help you all can give me. 47540 describes the placement of a completely internal stent via a new access with separate placement of an external or internal/external biliary catheter. Inpatient procedure costs include the hospital payment for the entire stay associated with the surgery. ksam?mUUe , The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. The procedure is reported with 47532 when performed via a new access, or with 47531 when performed via an existing access. 0000264825 00000 n 1996 Apr;10(4):426-8. doi: 10.1007/BF00191631. Cpt Code For Laparoscopic Cholecystectomy - Peekapoo - S. The CPT code for this is 47564. 0. Because imaging guidance is performed, be sure the ultrasound, CT, or MRI tech does not charge a guidance code when the access uses one of these imaging guidance modalities. endstream endobj 528 0 obj <>/Metadata 119 0 R/Names 529 0 R/Outlines 81 0 R/PageLabels 116 0 R/Pages 118 0 R/StructTreeRoot 121 0 R/Type/Catalog/ViewerPreferences<>>> endobj 529 0 obj <> endobj 530 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC/ImageI]/Shading<>/XObject<>>>/Rotate 0/StructParents 8/TrimBox[0.0 0.0 595.276 841.89]/Type/Page>> endobj 531 0 obj [532 0 R 533 0 R] endobj 532 0 obj <>/Border[0 0 0]/H/N/Rect[435.42 52.6564 534.666 45.5704]/StructParent 29/Subtype/Link/Type/Annot>> endobj 533 0 obj <>/Border[0 0 0]/H/N/Rect[490.0 775.236 560.91 751.97]/StructParent 9/Subtype/Link/Type/Annot>> endobj 534 0 obj <> endobj 535 0 obj <> endobj 536 0 obj <>stream Code 47541 describes the creation of an access into the biliary system for subsequent use by an endoscopist. Please type the correct Captcha word to see email ID. Percutaneous cholecystostomy is the image-guided placement of a drainage catheter into the gallbladder lumen. Next month, well cover CPT updates for percutaneous neurologic intervention. 0000214528 00000 n At the time of surgery, three of the 100 patients had gallbladders judged too severely inflamed for laparoscopic cholecystectomy. Pressure necrosis of the underlying skin also complicates G-tube replacement. 0000282005 00000 n 0000312225 00000 n 0000010370 00000 n %PDF-1.4 % DOI: 10.15406/mojcr.2020.10.00346 Figure 1 Severe acute cholecystitis. -, Endoscopy. 40500. The user must multiply the rate obtained from the software by 1,000 to report specific procedure discharges per 1,000 hospital discharges.] The following codes involve placement of an external or internal/external biliary drainage catheter: They therefore underwent laparoscopic placement of a cholecystostomy tube. procedure coding system The new system is intended to replace ICD-9-CM Volume 3 for reporting inpatient procedures RLM.MD ICD-10-PCS 2. 0000295215 00000 n Offer. CPT guidelines instruct us to code separately for each catheter placement, replacement, conversion, or removal. Do not submit 47533 or 47534 with this procedure. 0000263069 00000 n A total of eight patients were admitted to the hospital following postanesthesia care, six of these eight patients were discharged on the first postoperative day. 0000262641 00000 n Adjuncts to bowel management for fecal incontinence and constipation, the role of surgery; appendicostomy, cecostomy, neoappendicostomy, and colonic resection. Example: The patient recently underwent external biliary drainage catheter placement for biliary obstruction and infection. In March, we covered urinary intervention. For 2016, the biggest CPT coding changes affecting interventional radiology occur within the subspecialties of urinary, biliary, and neurologic intervention. Intraoperatively there was evidence of acute gangrenous cholecystitis with a lot of dense thick adhesions around the gallbladder. 4. Percutaneous placement of cholecystostomy drain has been used in . It also provides access for diagnostic cholangiography. The five procedures are laparoscopic cholecystectomy (CPT procedure code 47562 for outpatient surgeries and ICD-9 procedure code 5123 for inpatient surgeries), laparoscopic appendectomy (CPT 44970 and ICD-9 procedure code 4701), arthrodesis (CPT 22845 and 22551; and ICD-9 procedure code 8102), laparoscopic total hysterectomy (CPT 58570, 58571, 58572, and 58573; and ICD-9 procedure code 6841), and laparoscopic vaginal hysterectomy (CPT 58552, 58553, and 58554; and ICD-9 procedure code 6841). 0000009762 00000 n No Intervention: no drain insertion. 0000305890 00000 n For all other claims, report the appropriate CPT code for laparoscopy, surgical; cholecystectomy (any method), and the appropriate CPT code for laparoscopy, surgical: cholecystectomy with cholangiography. 0000013171 00000 n Patient subsequently underwent HIDA scan which was positive for cystic duct obstruction. What is a cholecystostomy tube? 0000265145 00000 n Cholecystostomy is the procedure of putting a tube in gall bladder. Do not use this code for removal of debris or sludge, and do not use it with an attempted procedure modifier if stone retrieval is attempted, but no stones are identified. There are 14 new biliary intervention codes for 2016 (see New Biliary Intervention Codes for 2016). Code 47536 describes tube exchange in the bile duct, which is not the gallbladder. A catheter placement, replacement, conversion, or removal code can additionally be submitted if done. 2006). The catheter and wire are secured in position and sent to endoscopy, where the gastroenterologist advances an endoscope into the duodenum, snares the wire, and uses this wire to advance a stent or balloon to complete that portion of the procedure. 0000290962 00000 n 0000196901 00000 n The definition for the Drainage root operation provided in the 2013 ICD-10-PCS Reference Manual is "Taking or letting out fluids and/or gases from a body part.". As explained in the February 2019 CPT Assistant: Gastrostomy tubes (G-tubes) may be inadvertently removed if traction is placed on the tube. In such situations, the tract may be difficult to access and require dilation and guidewires to place a new tube. official website and that any information you provide is encrypted CPT Code For Laparoscopic Cholecystectomy With Firefly Firefly is used to inject a dye named ICG (Indocyanine green) before . -. Authors Joseph T Church 1 , Daniel H Teitelbaum, Marcus D Jarboe. Laparoscopic Cecostomy Tube Placement Surg Laparosc Endosc Percutan Tech. 0000313739 00000 n Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version | Opera | Terms and Conditions | Privacy Policy, Laparoscopic cholecystostomy tube placement. #1. In the drain insertion group, investigators use the closed suction drain through a lateral 5-mm trocar and placed it in right subhepatic space. Bookshelf Agastrostomy tube, or G-tube, is atube inserted through the abdomen to deliver nutrition directly into the stomach. (not the gallbladder). LC tube placement can also be used where interventional radiology (IR) services are not available. The stent codes may be used more than two times in individuals requiring multiple stents to treat multiple stenoses in different ducts. 0 doi: 10.1016/j.suc.2008.07.005. CPT code 47562 describes a diagnostic laparoscopy and surgical removal of the gallbladder. National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894, Web Policies 0000158048 00000 n He was febrile, had a white count of 19,000. (30.1%) including laparoscopic (n = 31) or laparoscopic converted to open and open cholecystectomy (n = 14). +CPT Code 47550 is an Add-On code and must be reported with a primary procedure. Patient had CT scan on 10/21/2009 demonstrating a persistent . 0000011145 00000 n Cholangioplasty is bundled when performed at the same site as a biliary stent deployment. Aug 4, 2010 #2 Its 47490 and 75989 Thanks, Abdul Saleem CPC . This allows for performing interval laparoscopic cholecystectomy in a safe manner. Anticipating difficult cholecystectomy. The five major cross-over procedures were identified as the highest-volume procedures billed by surgeons in 2013 where at least 10 percent of the surgeries occurred at an inpatient hospital and at least 10 percent occurred in a hospital outpatient setting. Control of postoperative pain, nausea, and vomiting are important to successful same day discharge, and admission rates despite planned same day discharge are reported to be 1-39%; patients older than age 50 may be at increased risk for admission (Kasem, et al. Next we discuss outpatient management of cholecystostomy tubes and an algorithm for tube . Surgery was recommended. Best answers. The following list(s) of codes is provided for reference purposes only and may not be all inclusive. As it grows further, it may compromise additional ducts requiring three or four catheters for successful drainage). sharing sensitive information, make sure youre on a federal Over the last 3 decades, the laparoscopic skill of the surgeons has been much more widely adopted and the conversion rate is much lower. 47535 describes the conversion of an existing external biliary drainage catheter to an internal/external catheter (removal of the external catheter and placement of the internal/external catheter over a wire, which requires crossing of the distal common bile duct into the small intestine), and includes diagnostic imaging. White count of 20,000. Langenbecks Arch Surg 2012; 397:909. Bethesda, MD 20894, Web Policies 2006 Apr;20(4):624-7. doi: 10.1007/s00464-005-0343-y. If this is your first visit, be sure to check out the. ICD-10 Code K22.11 Ulcer of Esophagus with bleeding. 47562 Laparoscopy, surgical; cholecystectomy47563 Laparoscopy, surgical; cholecystectomy with cholangiography47564 Laparoscopy, surgical; cholecystectomy with exploration of common duct. Successful CT-guided cholecystostomy tube placement as described above. Percutaneous placement of cholecystostomy drain has been used in critically ill patients suffering from sepsis from acute cholecystitis, and patients with significant comorbidities who would not tolerate a prolonged procedure. PostOperative Diagnosis: Acute and chronic cholecystitis with cholelithiasis. There was no significant difference in mortality between the two groups (4/178 (weighted percentage 1.2%) in the T-tube group versus 1/181 (0.6%) in the primary closure group; RR 2.25; 95% CI 0.55 to 9.25; six trials). Based on a work at https://medcraveonline.com Contact Us, 2014-2023 MedCrave Group. 0000267204 00000 n Cholangiography (47532 and 47531) is performed to evaluate the biliary system for patency, stones, strictures, malignancy, and leaks. Copyright 2023, AAPC Laparoscopic cholecystectomy is the best treatment for acute calculus cholecystitis when performed within 72 hours. This site needs JavaScript to work properly. Frazee RC, Roberts JW, Symmonds R, et al. 0000264720 00000 n The cholangiogram codes may be used as a base code for +47542, +47543, and +47544, but only if a catheter is not placed, replaced, or converted. He was initially admitted to the ICU and placed on intravenous inotropic support. 40810. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. +47542 describes cholangioplasty (balloon dilation) of any bile duct for treatment of a stenosis or occlusion, and can also be used to report balloon dilation of the ampullary sphincter (sphincteroplasty) for subsequent stone extraction. Diagnostic cholangiogram is performed (47531), demonstrating a distal common bile duct stenosis. Median tube placement duration was 25 days (range 1-211). Please help me with the coding of this procedure. Could you recommend a resource that would help me with gastrostomy (NG, JG, NJ, etc) diagnosis coding? These abnormalities can occur anywhere in the collecting system, but most often are between the ampullary sphincter of the distal common bile duct and the bifurcation of the more proximal common bile duct. They therefore underwent laparoscopic placement of a cholecystostomy tube. The external biliary catheter is removed over a wire and an internal/external catheter is advanced with the distal tip in the small intestine and secured in position (Add 47535 for the conversion of an external catheter to an internal/external catheter. This may limit the number of cholangioplasties submitted in patients with sclerosing cholangitis. MOJ Clin Med Case Rep. 2020;10(3):7072. 47537 describes the removal of an existing external or internal/external biliary drainage catheter, and includes diagnostic imaging. A 12 French Foley catheter was inserted through a right upper quadrant 5mm port site and inserted into the fundus of the gallbladder. 2524 N. Broadway Edmond Oklahoma 73034. What is documented here is not a percutaneous procedure. MeSH I think the new incision does count, and the code includes the imaging but I don't think the imaging needs to happen per se. Gallbladder wall was very thick-walled and there was generalized excessive bleeding from around the liver bed. In these cases, replacement of the G-tube is straightforward and would be reported with code 43762, CPT Assistantcontinues, and provides the following example: A 76-year-old female suffering from significant malnutrition previously required placement of a percutaneous gastrostomy tube. In this arm, investigators perform only laparoscopic cholecystectomy, and not insert a drain. 0000266148 00000 n Here's what you need to know to be sure your coding is current and correct. 47536 Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation This minimally invasive procedure can aid in patient stabilization in order to enable a more measured surgical approach with time for therapeutic planning. At this point it was decided to perform LC tube placement in order to avoid injury to the vital structures. This article includes all medical codes you will need to report right hip pain and related specific ICD 10 & 11 codes. Patient was readmitted about 6 weeks later with acute changes in mental status, secondary to acute aspiration pneumonia. Twelve biliary CPT codes were deleted for 2016 (47500, 47505, 47510, 47511, 47525, 47530, 47630, 74305, 74320, 74327, 75980, and 75982), and five previously recommended endoscopic codes (47552, 47553, 47554, 47555, and 47556) should no longer be used for percutaneous procedures because new codes more accurately describe these procedures. Postcholecystectomy syndrome. The incision . A thin tube is placed into the gallbladder. If more than two separate sites are treated with balloon dilation, no additional codes are submitted for the additional cholangioplasties. It is performed under x-ray or ultrasound. 0000265781 00000 n Figure 2 Laparoscopic cholecystostomy tube. Han SP. When done via an existing access, submit a code describing a catheter exchange, removal, or conversion (e.g., 47535-47537). ** Cholecystectomy, Laparoscopic, Cholangiogram Intraoperative with Laparoscopic Cholecystectomy, ** Cholecystectomy, Open, Cholangiogram Intraoperative with Open Cholecystectomy. Laparoscopic cholecystostomy tube placement can be a useful adjunct in situations where there is severe acute inflammation of the gallbladder and can avoid conversion to open procedure. 1991 Mar;161(3):339-44 procedure codes for laparoscopic cholecystectomy. 0000008016 00000 n Cited Here | A retrospective observational study of image-guided percutaneous cholecystostomy was performed from 2004 to 2016. Figure 2 Laparoscopic cholecystostomy tube. Would you like email updates of new search results? Earn CEUs and the respect of your peers. 'hrC*@Z]c\q aL3VLoTY$LEg^{EUaAmaqiyeU6>1Jg/7|[C? We are looking for thought leaders to contribute content to AAPCs Knowledge Center. Hence IR could not reposition the percutaneous drain. 47538 describes the placement of a completely internal stent (metallic or plastic) via an existing access (prior external biliary catheter or internal/external biliary catheter access) and includes exchange of an existing externally draining biliary catheter (if done); down-conversion to an external catheter (when the original catheter is an internal/external catheter); or removal of a catheter at the end of the procedure. Nov 5, 2009. I would agree with using 47579 here. This is an open access article distributed under the terms of the, The cholangiogram may be performed via a new access (placing a needle or catheter through the right side or anterior abdominal wall into the right or left bile ducts respectively) or via a pre-existing catheter, usually an existing biliary catheter. Clinical Documentation and Prior Authorization Required Tufts healh plan required authorization for below services. Another example is when gastric contents have leaked and there is maceration, ulceration, or necrosis of the surrounding skin that requires debridement and management of a larger-than-normal gastrostomy tract for tube replacement. We report three patients with acute . This work is not the same as the total work included in code 47560. The coding advice may or may not be outdated. Percutaneous transhepatic gallbladder drainage (PTGBD) is indicated for patients with acute cholecystitis (AC) who are not indicated for urgent surgery, but external tubes reduce quality of life (QOL) while waiting for elective surgery. Privacy Policy | Terms & Conditions | Contact Us. At the time of surgery, three of the 100 patients had gallbladders judged too severely inflamed for laparoscopic cholecystectomy. 0000292586 00000 n Patient was discharged home the same day. Surg Clin North Am. He was on the AAPC National Advisory Board from 2005-2009, and is a member of the Nashville, Tenn., local chapter. Hence decided to perform LCtube placement. hbbc`b``3 1 cholangioplasty, biopsy, and stone extraction If the cystic duct is not patent, the cholecystostomy tube continues to be connected to a drainage bag. CPT Code For Laparoscopic Cholecystectomy With Firefly Firefly is used to inject a dye named ICG . It was therefore difficult to dissect the anatomical structures. Laparoscopic Tube Cholecystostomy: Still Useful in the Management of Complicated Acute Cholecystitis. Percutaneous biliary stent placements J Laparoendosc Adv Surg Tech A. Tech & Innovation in Healthcare eNewsletter, Excision of Benign or Malignant Skin Lesion, Surgical Complication Diagnostic Coding: Quick Tip. 0000101920 00000 n 0000011634 00000 n 0000204448 00000 n 0000267732 00000 n As of January 1, 2019, 43760 is no longer valid. Usefulness of Laparoscopic Cholecystostomy in Children With Complicated Choledochal Cyst. 0000211094 00000 n 0000211822 00000 n permits unrestricted use, distribution, and build upon your work non-commercially. CPT Code For Cholecystostomy Tube Removal Cholecystostomy tube is placed inside the bladder for decompression of infected, distended and inflamed gallbladder. Submit 47536 for each catheter exchanged at the same session. At that time the RUC recommended a wRVU of 12.11 for CPT code 47563, however, CMS reduced the value to 11.47. As well, all of the new codes bundle the use of imaging guidance, including fluoroscopy, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). 0000011897 00000 n How do I bill this? It is sometimes used in cases of cholecystitis where the person is ill, and there is a need to delay or defer cholecystectomy. 6 weeks from the time of the original surgery, the patient underwent elective outpatient procedure - laparoscopic cholecystectomy was performed and removal of cholecystostomy tube. Acute cholecystitis and recurrent biliary colic are the most common indications for performing laparoscopic cholecystectomy. 0000267827 00000 n 530.4 Perforation of Esophagus (ICD 9) ICD-10 Code K22.4 Dyskinesia of Esophagus. 2015 Dec;25(6):e180-3. Before +47544 describes percutaneous biliary stone extraction by any method, and includes removal of stone(s) with a basket and/or pushed through the ampulla with a balloon. H. HNISHA Networker. Example: A patient has an existing external biliary drainage catheter. You are using an out of date browser. 530.3 Stricture and stenosis of esophagus (ICD 9) ICD-10 Code K22.3 Perforation of Esophagus. The biliary system is divided into right- and left-sided bile ducts; however, these ducts divide further into multiple smaller branches that may be individually accessed and drained, depending on the pathology treated (e.g., Klatskin tumor is a cholangiocarcinoma that has involved and caused bifurcation occlusions of the common bile duct. 0000264188 00000 n Gurusamy KS, Koti R, Davidson BR. use codes 47505,74305,47525,75984 for tube check and change of cholecystostomy tube if the tube was . If it is necessary to repeat an endoscopy to control bleeding at a separate patient encounter on the One of the most common abdominal surgical procedures is cholecystectomy. Laparoscopic cholecystostomy as an alternative to open cholecystectomy and percutaneous cholecystostomy in a rural setting. 0000101850 00000 n Intent was lap cholecystectomy, but didn't do because of inflammation, so placed drain. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Question: You recommend code 47536 for cholecystostomy tube change in the IR reference instead of 47490-52. 0000264613 00000 n 0000264401 00000 n Patient is a 74-year-old male from a nursing home with a past medical history of atrial fibrillation - on Coumadin, stroke, diabetes mellitus, hypertension, chronic kidney disease, and a prior history of PEG tube -was admitted to the hospital with septic shock and diabetic ketoacidosis. The catheter is removed over a guidewire and a sheath is placed up to the abnormality. 0000214917 00000 n 0000012348 00000 n Laparoscopic tube cholecystostomy: still useful in the management of complicated acute cholecystitis. Acute calculus cholecystitis: Review of current best practices. A 2018 study demonstrated no difference in mortality between percutaneous . All three codes include an initial cholangiogram (47532, 47531) and all imaging guidance (e.g., fluoroscopy, ultrasound, CT, MRI). Prior to 2019, a single code, 43760, was used to report replacement of a G-tube without imaging or endoscopic guidance. Malone Antegrade Continence Enemas vs. Cecostomy vs. Transanal Irrigation-What Is New and How Do We Counsel Our Patients. 42330. 0000188361 00000 n Readmission rates range from 0-8%; common causes for readmission after same day discharge include pain, intra-abdominal fluid collections, bile leaks, and bile duct stones (Sherigar, et al. You can easily access coupons about "Cpt Code Cholecystostomy Tube Placement" by clicking on the most relevant deal below. which Diagnosis of acute cholecystitis was made. Epub 2020 Nov 20. A percutaneous cholecystostomy is a procedure to place a drainage catheter in the gallbladder through a tiny entry hole made in the stomach wall. For a better experience, please enable JavaScript in your browser before proceeding. H\n0@ 0000262177 00000 n )GxGxGxGxGxGCa +CPT Code 47550 is an Add-On code and must be reported with a . The gallbladder itself appeared thickened, contracted and was very friable (Figure 1). The 2023 edition of ICD-10-CM K91.5 became effective on October 1, 2022. 0000232694 00000 n You must log in or register to reply here. The percutaneous cholecystostomy course may be transhepatic, where the catheter tra-verses the liver before entering the gallblad-der, or gallbladder access may be directly Image-Guided Cholecystostomy Tube Placement: Short- and Long-Term Outcomes of Transhepatic Versus Transperitoneal Placement Michael D. Beland1 Lakir Patel2 Sun H. Ahn1 15.00 26.60 58572 Total Laparoscopic hysterectomy, uterus > 250g ; 17.71 30.51 Total spending includes insurer and enrollee payments for the facility portion of the surgical procedure; the physician portion billed on a separate professional claim is not included. Post-procedure, 16 patients (43.24%) went on to have LC, of which 50% (eight patients) required conversion to open surgery and 25% (four . The gastrostomy catheter has become clogged; attempts to establish luminal patency have been unsuccessful.

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