Urology Coding Alert

Question: A previously diverted patient presented with a rupture of his diversional intestinal pouch. The physician's operative report indicates that she repaired a 10-cm hole in the dome of the pouch. Would this be considered a repair of the bladder? Ohio Subscriber Answer: You have two options neither of which involves the bladder repair codes for coding the pouch repair. Your first option is to use the unlisted-procedure code for the pouch repair: 44799 (Unlisted procedure, intestine). The drawback to using this unlisted-procedure code, as with any unlisted-procedure code, is the inherent difficulty of getting these codes paid. If you choose this option, you will need to include an extremely well-documented operative report when you submit your claim. Your second option is to choose between the enteror-rhaphy code, 44602 (Suture of small intestine [enteror-rhaphy] for perforated ulcer, diverticulum, wound, injury or rupture; single perforation), and the colorrhaphy code, 44604 (Suture of large intestine [colorrhaphy] for perforated ulcer, diverticulum, wound, injury or rupture [single or multiple perforations]; without colostomy), depending on the segment of the bowel that was initially used for the pouch construction or the anatomic bowel segment ruptured.