General Surgery Coding Alert

Question: What defines a low-pelvic anastomosis as opposed to a partial colectomy -- is it the coloproctostomy hook-up or the location below the peritoneal reflection that distinguishes the two?

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Answer: Partial colectomy describes the surgical removal of a colon section. The surgeon can reconnect the end(s) of the resected bowel in various ways, one of which is a coloproctostomy. Another name for coloproctostomy is "low-pelvic anastomosis," which involves suturing the resected end of the colon to the rectum.

In other words, a partial colectomy may include a low-pelvic anastomosis, or may involve a different method/location of attaching the colon following resection. The CPT® codes help you see the different surgical options for reconnecting the colon as part of a partial colectomy:

• 44204 -- Laparoscopy, surgical; colectomy, partial, with anastomosis
• 44206 -- ... colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure)
• 44207 -- ... colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)
• 44208 -- ... colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy
• 44140 -- Colectomy, partial; with anastomosis
• 44141 -- ... with skin level cecostomy or colostomy
• 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.

Notice that CPT® doesn't distinguish any of the codes based on what colon section the surgeon removes, such as location below the peritoneal reflection.