General Surgery Coding Alert

Question: How do I code a laparoscopically assisted colectomy? Specifically, my surgeon used a laparoscope to mobilize the colon, but the colectomy itself was performed through a separate incision. After the colon was mobilized, the camera was removed but the trocars were left in place. An incision (similar to a small appendix transverse incision) was made to open the abdominal cavity. The cecum, terminal ileum and a portion of the ascending colon were brought through the incision for resection and anastomosis.

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Answer: The correct code for this procedure is 44202 (intestinal resection, with anastomosis [intra or extracorporeal]), says Kathleen Mueller, RN, CPC, CCS-P, an independent general surgery coding and reimbursement specialist in Lenzburg, Ill. This procedure is sometimes performed for small resections performed because the patient has, for example, diverticulosis or a broad-based polyp that must be removed.

The key to understanding this code is the term intra or extracorporeal, Mueller says. If the resection is performed laparoscopically, it is considered intracorporeal. However, to perform an extracorporeal (i.e., outside the body) resection, an incision must be made that is just large enough to pull the affected part of the bowel out of the body which is what the surgeon here has done.

In either case, 44202 applies. Even when the small incision is made and the resection is performed outside the body, most of the work including mobilization of the colon is done laparoscopically.

By using the laparoscope to mobilize the bowel and then making a small incision to resect and anastomose the bowel, the surgeon avoided the need for a much larger incision required to perform an open procedure, Mueller says. She notes that this procedure would not typically be used on cancer patients, where the affected areas may be considerably larger.