2 colectomies

JenReyn99

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I have a report where the doc did multiple resections of multiple sections of the colon. He didn't perform an anastomosis until the last one was done though, so I'm thinking I can't code both. Any help is appreciated.

Here's part of the report: The cecum and ascending colon were volvulized and resected using ligature and silk ties. The entire colon was dilated. There was no decompression distal to the volvulus. I followed the colon to a site of obstruction which was a sigmoid mass which appeared to be a cancer. The mass was excised between clamps and an end-colostomy of the transvers and descending colon was created in the left abdomen. An ileostomy was created in the right abdomen as the ascending colon had been resected and after noting no bleeding colostomy bags were placed following primary maturation of both ostomies.

I'm thinking this should be: 44141, and 44310, but I'm very shaky on this one. Thanks for the help.
 
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I think this is 44144 but he did more work than this describes since he had to resect the sigmoid as well. You need to check with the surgeon. Technically from what I can tell the colostomy is actually a mucous fistula. I think I would code this as 44143 (he did the work for this even though the colostomy is a mucous fistula) and 44143-52 (he didn't do the mucous fistula here) but I'm not really sure. Any thoughts anyone?
 

surgonc87

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So how does the anatomy looks now, where is the flow of things...so fecal matter is coming out of the ileum and the colostomy is the mucous fistula as there is no continuum? jackpot!? 44144?


http://pgblazer.com/2010/12/mucous-fistula-definition.html

Mucous fistula is a type of abdominal stoma. (Abdominal stoma is an artificial opening created in the abdominal wall as an alternate path for feces or urine to reach outside the body.)
But in certain cases, the distal non functioning part of bowel is also brought out through a stoma
Such a stoma is known as a mucous fistula
It appears small, flat and pinkish red
It discharges only mucus – no fecal matter
 
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JenReyn99

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thank you so much. This makes total sense, and I totally agree. Just haven't had this one before, and I haven't done too many colectomies. Thanks!
 

surgonc87

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I havent had this either, just figured it out, colorectal surgeon gave me a clue and this then bell rang. Glad we all understand now
MS
 
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Sorry I mistyped. I would code 44144 (that's the sigmoid colectomy and colostomy) and 44141-52 (it's an ileostomy not a cecostomy).

He did more work than either of the codes submitted separately. I would check with the surgeon.

Thanks to all of you. I'm glad I can help. I think I learn more from you than you do from me!
 
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