General Surgery Coding Alert

Question: Following a sigmoid colectomy with end-to-end anastomosis from descending colon to anterior wall of distal sigmoid colon, patient returns to surgery three days later for the following:

Surgeon opens peritoneal cavity to find descending colon disrupted from distal segment of anastomosis, spilling bowel contents. He closed the ruptured anastomosis with sutures in transverse fashion (perpendicular to the long axis of the bowel). Upon further inspection, surgeon resected a dusky-looking 10 cm of descending colon as an end colostomy to a site in the lower left quadrant.

Can I report 44143 and 44604 for the return procedures?

Indiana Subscriber

Answer: You are correct to report two codes because the surgeon describes repair and resection at separate sites. As opposed to your recommendation, the proper codes are as follows:

• 44141 — Colectomy, partial; with skin level cecostomy or colostomy
• 44604 — Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); without colostomy.

Because the surgeon performs the procedures at separate sites, you should append modifier 59 (Distinct procedural service) to 44604 to override the Correct Coding Initiative (CCI) edit that bundles the two codes.

Code 44143 (Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure) describes the creation of a permanent colostomy with closure of the distal colon. It appears that this case does not involve that type of procedure, but instead involves a temporary colostomy to allow healing, with the expectation that the surgeon will subsequently return the patient to a normal digestive route.