General Surgery Coding Alert

Question: When reversing a colostomy, the surgeon resects the ends of the colon to prepare for an end-to-end anastomosis. The resected ends show no pathology -- they're resected only to create a healthy anastomosis. Should we bill 44626 or 44620 for the service?

Pennsylvania Subscriber

Answer: You would usually code the service you describe as 44625 (Closure of enterostomy, large or small intestine; with resection and anastomosis other than colorectal). You should not report 44626 (... with resection and colorectal anastomosis [e.g., closure of Hartmann type procedure) for the service you describe. Reserve 44626 for situations when the surgeon attaches the colon directly to the rectum rather than to another piece of colon.

If the surgeon simply takes down the colostomy and sews closed the hole in the colon, you should report the parent code 44620 (Closure of enterostomy, large or small intestine). The surgeon would typically use this procedure only when the patient has a loop colostomy for a very short period of time.

Medical necessity: Creating a healthy anastomosis is medically necessary in the case you describe, so the surgeon should get paid for the work. Choosing 44625 is the best way to ensure proper reimbursement.