General Surgery Coding Alert

Question:  On August 4 a patient had a total colectomy (44150). He developed an anastomotic leak with fistula and intra-abdominal abscess and had to be taken back to surgery on August 18 for exploratory laparotomy with drainage of abscess, end ileostomy, and mucus fistula creation. The surgeon used a loop of small bowel and brought the proximal end up as a matured colostomy and made a mucus fistual with the other end. What code should I use for this procedure?

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Answer: You should report either 49020 (Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; open) or 49060 (Drainage of retroperitoneal abscess; open), depending on where the abscess is. Then, report 44310 (Ileostomy or jejunostomy, non-tube) for the creation of the ileostomy.

Don't miss: You'll need to append modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period) to both codes that you report since the patient is in the global period of the original procedure.