General Surgery Coding Alert

Question: What codes would you use for lower anterior resection with anal anastomosis and divered ileostomy with mobilization of splenic flexure, which was converted to an open procedure?

Louisiana Subscriber

Answer: You'll report the open procedure codes for this case. Take a look at 44145 (Colectomy, partial; with coloproctostomy [low pelvic anastomosis]) for the lower anterior resection (LAR, which is a colectomy) and +44139 (Mobilization [take-down] of splenic flexure performed in conjunction with partial colectomy [list separately in addition to primary procedure]) for the take-down of the splenic flexure.

When your surgeon converts a surgical lap procedure to an open procedure, you can only report the open procedure code. You'll use the diagnosis code to tell the payer about the lap-toopen conversion. Use V64.41 (Laparoscopic surgical procedure converted to open procedure) as a secondary diagnosis to document on the claim that the surgeon converted from laparoscopic to open technique. Using V64.41 does not affect the primary diagnosis.

Because open conversion cases often take much longer than a similar procedure that is open from the start, you might be able to use modifier 22 (Increased procedural services). The surgeon must document the extra work and time for you to be able to use this modifier.