Colostomy and mucous fistula


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Would you just code this as 44320 ONLY? Or would you add 44320 and 45999 for the mucous fistula as well.

Operation Performed: Colostomy and mucous fistula

Findings (Normal + Abnormal): 2.3 day old neonate born with anorectal malformation. Found to have a distended, redundant sigmoid colon. Colostomy created just beyond the junction of the descending and sigmoid colon. Distal sigmoid and rectum were irrigated essentially til clear.

Description of Procedure: With appropriate consent, the patient was brought into the operating room and general anesthesia was induced. The consent was confirmed, the patient was positioned with appropriate padding, and a time-out was performed. The abdomen was then prepped and draped in a sterile manner. A LLQ oblique incision was made and carried down through the muscle and fascia till the peritoneal cavity was entered. The underlying bowel was inspected and the sigmoid colon delivered into the wound. After confirming the appropriate orientation of the bowel, a point was chosen in the proximal sigmoid and the mesocolon divided between ligatures. The bowel was then divided and briefly decompressed of gas. The divided ends of the bowel were then pulled to either end of the wound and the intervening fascia closed with interrupted 3-0 PDS suture. The proximal end of the bowel was secured to the fascia with interrupted 4-0 vicryl sutures. The intervening skin was approximated with subcuticular 4-0 vicryl sutures. The mucous fistula in the medial end of the wound was then trimmed down to skin level and matured to the skin with interrupted 4-0 vicryl sutures. The colostomy in the lateral end of the wound was inspected, the edges of the bowel inverted and matured to the skin, also with interrupted 4-0 vicryl sutures. Some interrupted 4-0 Monocryl sutures were used to reinforce the skin closure. A red rubber robinson catheter was then introduced into the mucous fistula and the distal bowel was irrigated with saline essentially till clear. Sterile dressings were applied. This completed the procedure. The patient was then returned to the NICU in satisfactory condition.

Rapid Frozen Section Telephone Diagnosis: n/a
Specimens Removed: Fragments of mucous fistula
Drains/Packs: none