General Surgery Coding Alert

Question: Is a "takedown" ileostomy the same as a "reversal" ileostomy? How should I code the procedure?

Arizona Subscriber

Answer: Yes, a reversal or takedown ileostomy refers to the same procedure, which is closure of an enterostomy of the small intestine. The general code for the procedure is 44620 (Closure of enterostomy, large or small intestine).

An ileostomy involves constructing a surgical opening in the abdominal wall and bringing a loop of small intestine to the skin surface. The takedown reverses the ileostomy by surgically repairing the ileum loop that formed the stoma and closing the incision.

Watch for more: A simple reversal may not be the only step your surgeon takes. You should carefully check the documentation to see if the surgeon performed additional work described by the following two codes:

44625 -- ... with resection and anastomosis other than colorectal

44626 -- ... with resection and colorectal anastomosis (e.g., closure of Hartmann type procedure).

Don't confuse reversal with revision: As opposed to reversal, CPT provides separate codes for ileostomy revision surgery, as follows:

44312 -- Revision of ileostomy; simple (release of superficial scar) (separate procedure)

44314 -- ... complicated (reconstruction in-depth) (separate procedure).