General Surgery Coding Alert

Question: Please help with coding the following case:

Made midline abdominal incision, mobilized ileocecal junction, mobilized splenic flexure, divided terminal ileum proximal to obstruction, divided and ligated ascending colon. Mobilized rectosigmoid junction, divided upper rectum and distal sigmoid junction. End to end anastomosis created, circular opening made for ileostomy with stapled end of ileum pulled through. French blake tube placed into pelvis through separate stab wound, secured to skin at exit site, stoma bag applied.

Pennsylvania Subscriber

Answer: The best code for this case is 44145 (Colectomy, partial; with coloproctostomy [low pelvic anastomosis]). The surgical note documents an ileostomy, but you can’t bill it separately.  An ileostomy is usually temporary for these types of cases, and is included in the colectomy code, when performed.

On the other hand, you can separately report the documented splenic flexure take down. In addition to 44145, you should report +44139 (Mobilization [take-down] of splenic flexure performed in conjunction with partial colectomy [list separately in addition to primary procedure]). A CPT^® text note following the code states, “Use 44139 in conjunction with 44140-44147.”