25 Tex. Admin. Code § 602.3 - Digestive System Treatments and Procedures

(a) Cholecystectomy with or without common bile duct exploration.

(1) Pancreatitis (inflammation of the pancreas).

(2) Bile duct injury (Injury to the tube between the liver and the bowel).

(3) Retained bile duct stones (stones remaining in the tube between the liver and the bowel).

(4) Bile duct stenosis or occlusion (narrowing or obstruction of the tube between the liver and the bowel).

(5) Injury to the bowel and/or intestinal obstruction.

(6) Bile leak (leak of bile from end of gallbladder duct or variant duct from the liver).

(b) Bariatric surgery (including gastric bypass (Roux-en-Y), biliopancreatic diversion with duodenal switch, sleeve gastrectomy, gastric banding).

(1) Failure of wound to heal or wound dehiscence (separation of wound).

(2) Injury to organs.

(3) Failure of device, including slippage or erosion requiring additional surgical procedure (for surgeries with implanted devices such as gastric banding).

(4) Obstructive symptoms requiring additional surgical procedure.

(5) Development of gallstones (Roux-En-Y).

(6) Development of metabolic and vitamin disorders (Roux-En-Y, biliopancreatic diversion with duodenal switch).

(7) Dumping syndrome causing nausea, vomiting, diarrhea, dizziness, sweating (Roux-En-Y, biliopancreatic diversion with duodenal switch).

(c) Pancreatectomy (subtotal or total and including Whipple Procedure (pancreaticoduodenectomy)).

(1) Pancreatitis (inflammation of the pancreas) (subtotal).

(2) Diabetes (total).

(3) Lifelong requirement of enzyme and digestive medication.

(4) Anastomotic leaks (leak of bile or intestinal fluids at surgical site where ducts and intestines are joined).

(d) Colectomy - total or subtotal.

(1) Permanent ileostomy.

(2) Injury to organs.

(3) Infection.

(4) Anastomotic leaks (leak of bowel contents at site where intestines reattached).

(5) Need for colostomy, permanent or temporary (subtotal colectomy).

(6) Incontinence (if ileoanal anastomosis)(unable to control bowel if small bowel attached directly to anus).

(e) Hepatobiliary drainage/intervention including percutaneous transhepatic cholangiography, percutaneous biliary drainage, percutaneous cholecystostomy, biliary stent placement (temporary or permanent), biliary stone removal/therapy (bile duct, gallbladder, and gallstone related procedures).

(1) Leakage of bile at the skin site or into the abdomen with possible peritonitis (inflammation of the abdominal lining and pain or if severe can be life threatening).

(2) Pancreatitis (inflammation of the pancreas).

(3) Hemobilia (bleeding into the bile ducts).

(4) Cholangitis, cholecystitis, sepsis (inflammation/infection of the bile ducts, gallbladder or blood).

(5) Pneumothorax (collapsed lung) or other pleural complications (complication involving chest cavity).

(f) Gastrointestinal tract stenting.

(1) Stent migration (stent moves from location in which it was placed).

(2) Esophageal/bowel perforation (creation of a hole or tear in the tube from the throat to the stomach or in the intestines).

(3) Tumor ingrowth or other obstruction of stent.

(4) For stent placement in the esophagus (tube from the throat to the stomach).

(A) Tracheal compression (narrowing of windpipe) with resulting or worsening of shortness of breath.

(B) Reflux (stomach contents passing up into esophagus or higher).

(C) Aspiration pneumonia (pneumonia from fluid getting in lungs) (if stent in lower part of the esophagus).

(D) Foreign body sensation (feeling like there is something in throat) (for stent placement in the upper esophagus).

(E) Tracheoesophageal fistula (formation of hole and connection between the windpipe and tube between mouth and stomach).

(g) Anti reflux procedures (surgical, endoscopic, including hiatal hernia repair).

(1) Dysphagia (difficulty swallowing).

(2) Stomach bloating, difficulty belching or vomiting.

(3) Esophageal perforation (hole in tube from mouth to stomach).

(4) Mediastinal abscess (infected collection in central portion of chest).

(5) Pneumothorax (collapsed lung).

(6) Device erosion into esophagus/surrounding tissues (procedures with implanted devices).

(h) Endoscopy simple (diagnostic endoscopy).

(1) Perforation (hole) of the esophagus (tube from mouth to stomach), stomach, small intestine (with leakage of contents into chest or abdomen), possibly requiring additional procedures including open surgery.

(2) Need for inclusion of or conversion to advanced endoscopy procedures with those risks (see subsection (i) of this section).

(i) Advanced upper endoscopic procedures (anything more than simple, diagnostic endoscopy) (ERCP, POEM, ESD, pancreatic fluid collection drainage/necrosectomy).

(1) Perforation (hole) of the esophagus, stomach, small intestine (with leakage of contents into chest or abdomen).

(2) Pancreatitis (inflammation of the pancreas) (for any procedures involving pancreas/pancreatic duct).

(3) Hemorrhage (Severe bleeding).

(4) Adjacent organ injury for transluminal procedures (e.g. liver biopsy, fluid drainage).

(5) Biliary peritonitis (bile leakage causing inflammation of the abdominal cavity).

(6) Sepsis (severe infection).

(j) Appendectomy.

(1) Injury to nearby organs.

(2) Infectious collection of fluid (abscess) requiring additional procedure(s).

(3) Normal appendix.

(k) Hemorrhoidectomy with/without fistulectomy or fissurectomy.

(1) Fecal incontinence (unable to control bowel).

(2) Anal stenosis (narrowing of the anus).

(3) Damage to bowel.

(4) Recurrent or new hemorrhoid(s).

(l) Repair and plastic operations on anus and rectum (anal fistula repair, rectovaginal fistula repair, rectal prolapse repair, anal sphincter repair, perineal reconstruction).

(1) Fecal incontinence (unable to control bowel).

(2) Anal stenosis (narrowing of the anus).

(3) Damage to bowel.

(m) Hernia repair (for example inguinal or ventral) (for hiatal hernia repair see subsection (g) of this section).

(1) Injury to adjacent structures (bowel, bladder, blood vessels, nerves).

(2) Seroma (fluid) or hematoma (blood) collection at surgical site.

(3) Chronic pain.

(4) Testicular injury (for those of male sex).

(5) If mesh used, infection, failure, migration, or rejection of the mesh.

(6) Recurrence.

(n) Esophageal dilatation (opening a narrowing of the tube between the mouth and the stomach).

(1) Perforation of the esophagus (creation of hole in tube from mouth to stomach), with possible need for additional procedures including open surgery.

(2) Recurrent stenosis (return of narrowing of the tube from the mouth to the stomach).

(o) Gastrostomy/gastrojejunostomy open, percutaneous, or endoscopic (placement of tube directly between the skin and the stomach with surgical incision, puncture from the skin into the stomach, or puncture from the stomach out towards the skin with endoscopy (camera)).

(1) Damage to surrounding organs.

(2) Hemorrhage (severe bleeding).

(3) Peritonitis (irritation of the abdominal compartment).

(p) Pyloromyotomy (cutting of the muscle at the end of the stomach to treat blockage of the stomach outlet).

(1) Perforation (creation of a hole from the mucosa (inside of the stomach) to the outside of the stomach) possible requiring additional procedures or surgeries.

(2) Incomplete myotomy (incomplete cutting of the muscle) possibly requiring repeat procedure/surgery.

(3) Delayed gastric emptying (food takes longer to leave the stomach than normal).

(q) Colonoscopy. Perforation (creation of a hole in the intestine) possibly requiring additional procedures or open surgery.

Notes

25 Tex. Admin. Code § 602.3

Adopted by Texas Register, Volume 48, Number 51, December 22, 2023, TexReg 7985, eff. 12/26/2023; Amended by Texas Register, Volume 50, Number 20, May 16, 2025, TexReg 2968, eff. 5/25/2025