Urology Coding Alert

Question: How should I code an open removal of stones from an Indiana pouch? The operative report states that the previous midline incision was opened just cephald to the umbilicus, and dissection was taken down through this area carefully into the abdominal cavity. The doctor identified the pouch. He then placed stay sutures and opened the pouch. The urologist readily identified the two large stones and removed them intact. He introduced a  22-French cystoscope through the incision in the pouch and carefully inspected and irrigated the pouch interior.


Wisconsin Subscriber
Answer: Coding for the removal of the calculi depends on the segment of bowl or predominate segment used for the diversion and the abdominal pouch. If the predominant segment used for the diversion is colonic (large bowl), report 44025 (Colotomy, for exploration, biopsy[s], or foreign body removal). If the predominant segment used for the diversion is ileum (small bowl), report 44020 (Enterotomy, small intestine, other than duodenum; for exploration, biopsy[s], or foreign body removal).

You should report diagnosis code 936 (Foreign body in intestine and colon) for the stone in the bowl segment.

If your urologist placed a drainage tube in the bowl segment after he opened the bowl and removed the stone, also report 44300 (Enterostomy or cecostomy, tube [e.g., for decompression or feeding] [separate procedure]).