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Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer. Question: What is the correct code for a Graham patch omentoplasty used to repair a perforated duodenal ulcer? According to the operative report, the omentoplasty was performed after placing Lembert sutures of 3-0 silk. The stitch was left open, and a tongue of omentum was then placed over the ulcer and tied down with stitches. General Surgery Discussion List Participant Answer: The Graham patch uses sutures placed on either side of the perforation lemberted with the addition of the omentum. The surgeon uses sutures to secure the patch and close the perforation. CPT contains no specific code to describe Graham patch omentoplasty and the AMA and most coding experts advise against choosing ""the next best"" CPT code when reporting procedures without a distinct CPT code . Although you may contact individual carriers for instructions in some circumstances generally if the service you provide is not included in CPT the best code choice is an unlisted-procedure code (e.g. 44799 Unlisted procedure intestine). Use of the unlisted-procedure code should alert the payer that the claim requires individual attention. Be sure to include complete documentation explaining the procedure in full including the time and supplies involved. It may be helpful to compare the surgery to another similar procedure (e.g. 43840 Gastrorrhaphy suture of perforated duodenal or gastric ulcer wound or injury) to give the payer a ""point of reference"" to make a payment determination (it may speed payment to put this along with the title of the operation in box 19 of the CMS-1500 form). The payer will use this information to determine payment. Note: The AMA has a toll-free number (800-634-6922) to call if you have questions about CPT. AMA members receive four free inquiries annually. “
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