General Surgery Coding Alert

Question: Does the following note for a laparoscopic procedure describe a partial or total colectomy, and what is the proper code for the procedure? "The mid-sigmoid colon was grasped and then resection was performed utilizing the GIA staple gun and a ligature instrument to transect the mesocolon. Two colotomy incisions were performed on anti-mesocolon border and a staple gun was utilized to perform a functional end-to-end anastomosis."

Answer: The procedure you describe involves a partial colectomy, but this portion of the operative note doesn't provide enough information to assign a specific code.

Partial vs. total: Total colectomy involves removal of the entire colon from the ileocecal valve to the rectum. The sigmoid colon is only the last part of the colon before the rectum and removal of that alone is not a total colectomy.

Because they describe total laparoscopic colectomy, you shouldn't select a code from the range 44210-44212 (Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy ...) for the procedure you describe.

It's likely that you'd report the procedure you described as 44204 (Laparoscopy, surgical; colectomy, partial, with anastomosis). However, you might use a different code based on a full description of the procedure, such as 44206 (... colectomy, partial, with end colostomy and closure of distal segment [Hartmann type procedure]) if the surgeon created a colostomy.