General Surgery Coding Alert

Reporting partial colectomies can be difficult due to the clinical nature of the procedures. For example, most partial colectomies typically involve intestinal anastomosis and/or colostomy. Some of these procedures also include mucofistulas and ileocolostomies. Also, partial colectomies differ according to how the colon was approached and the section of colon removed. A coder unfamiliar with the anatomy of the digestive system may confuse the proper partial-colectomy code with another of the several procedures in CPT that include partial colectomy. A poorly written operative report can likewise result in incorrect coding.
Distinguishing Basic and Other Colectomies  
Partial-colectomy codes are found in the Digestive System/Surgery section of CPT under "Intestines (Except Rectum)." Although partial colectomy always involves resection, CPT does not use this term. Instead, colectomies make up the latter two-thirds of the "excision" subcategory. Of these codes, eight describe partial colectomies.
 
Code 44140 (colectomy, partial; with anastomosis) describes the basic partial colectomy, in which the diseased section of colon is removed and the distal and proximal ends of the remaining colon are stitched together.
 
Sometimes, the surgeon may suspect that the anastomosis will not take properly. In such cases, a cutaneous colostomy may be created with the colectomy. By creating the colostomy (typically, a loop colostomy), the surgeon diverts the fecal stream from the anastomosis, allowing it a better opportunity to heal. The remaining colon may also be stapled off to ensure that no intestinal contents (i.e., stool) disturb the healing anastomosis. When this type of colostomy is performed with a partial colectomy and anastomosis, 44141 (... with skin-level cecostomy or colostomy) should be reported. If, however, the distal segment of the colon is closed off and an end colostomy is created by bringing the proximal end of the colon to the skin surface, claim 44143 (... with end colostomy and closure of distal segment [Hartmann type procedure]).
 
Note: End colostomy is created by bringing an exposed end of resected colon to the skin surface. Loop colostomy involves pulling a loop of the remaining colon through a skin-level incision, where an opening is created to allow the rest of the colon to remain content-free.
 
Code 44144 (... with resection, with colostomy or ileostomy and creation of mucofistula) describes the creation of a mucofistula. The surgeon resects the diseased portion of colon (typically the left colon) but does not perform a primary anastomosis. There is enough distal colon remaining below the level of resection to reach skin level. This portion of distal colon is brought up into the incision and remains open. The proximal end of the functional colon is brought through a separate [...]