General Surgery Coding Alert
Takedown Only Separate With Partial Colectomy
Question: May I report takedown of the splenic flexure with a total colectomy (44150)? My surgeon recommends this, but I think it seems like unbundling. Virginia Subscriber Answer: No, you should not report +44139 (Mobilization [takedown] of splenic flexure performed in conjunction with partial colectomy [list separately in addition to primary procedure]) in addition to 44150 (Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy). The 44139 descriptor specifies "in conjunction with partial colectomy," whereas 44150 describes a total colectomy. In addition, CPT provides instructions that you should report add-on 44139 only with the following codes: - 44140 -- Colectomy, partial; with anastomosis - 44141 -- ... with skin level cecostomy or colostomy From a clinical standpoint, your surgeon is correct: A total colectomy necessarily involves mobilization of the splenic flexure. From a coding standpoint, the mobilization is an included component of a total colectomy. To report takedown of the splenic flexure in addition to a total colectomy would constitute unbundling.
- 44143 -- ... with end colostomy and closure of distal segment (Hartmann type procedure)
- 44144 -- ... with resection, with colostomy or ileostomy and creation of mucofistula
- 44145 -- ... with coloproctostomy (low pelvic anastomosis)
- 44146 -- ... with coloproctostomy (low pelvic anastomosis), with colostomy
- 44147 -- ... abdominal and transanal approach.
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