help please

Patient to surgery to remove and then replace gastrostomy tube. Surgeon had to repair the hole made by prior tube and then place new one. Not sure how to bill for closure of the removal. She says for placement use 43653.

PREOPERATIVE DIAGNOSIS: Dislodged peg feeding tube.

POSTOPERATIVE DIAGNOSIS: Same.

PROCEDURE: Diagnostic laparoscopy with removal of old PEG tube and placement of new gastrostomy tube.

INDICATIONS FOR PROCEDURE: The patient is a 56-year-old male who has ALS> He had a PEG placed about 9 days ago and unfortunately he had significant abdominal pain. Along that he had a CT that shows it is lodged in the rectus muscle. He now is to undergo removal of that and placement of a new G-tube.

DESCRIPTION OF PROCEDURE: In the supine position, the abdomen was prepped and draped in the usual fashion. After anesthetizing with 0.25% Marcaine, a left periumbilical incision was made. Under direct visualization, a 5 mm Optiview port was placed. The abdomen was insufflated with 15 cm of pressure. A 10 mm port was placed in the right upper quadrant, 5 mm more medial and inferiorly. You could see the omentum and stomach was sort of stuck up to the abdominal wall with freeing this down. There was actually a fairly good sized hole in the stomach that had no spillage. The opening was probably 2 cm. I therefore pulled this up and closed this with an Echelon blue load. That closed it very nicely. I removed a very small segment of the stomach to close it. The PEG tube was removed out of the remainder of the way. I therefore went more distal on the stomach and placed a pursestring of 2-0 Vicryl and inner one and an outer one. I then made an incision in the left upper quadrant away from the infection site and brought in a new 18 French gastrostomy tube. An opening was made in the pursestring and the feeding tube was placed inside this up to the stomach. It was insufflated with 7 mL of fluid. The 2 pursestrings were tied down. I then placed an additional 2-0 silk and then pulled the stomach up to the abdominal wall with the suture passer in 2 locations. On exam they had no other abnormalities were seen. It was irrigated and irrigation was removed. I did take cultures from the abdominal wall itself. The instruments and ports were removed. I then debrided that where the old PEG tube site was. The fascia was actually sort of broken down. I placed a figure-of-eight 0-silk to close that up and the skin edges of the incisions were closed with interrupted 4-0 Monocryl subcuticular stitch. The feeding tube was sutured in place with 3-0 nylon. The old PEG site was packed with a dry new gauze. Estimated blood loss was minimal. Sponge and needle counts were correct. He tolerated the procedure and was taken to the recovery room in satisfactory condition.

Any help is appreciated - thanks

help please