CPT coding for Open Right colectomy with end ileostomy

MarylouT

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Hello: Our surgeon performed an open right colectomy with end ileostomy. Normally for a right colectomy, we would use 44160 and the use 44310 for creation of an ileostomy However, 44160 states that an anastomosis is performed. With an end ileostomy, no anastomosis is performed. Also, this is a Medicare patient, so the use of the 52 modifier (reduced services) with 44160 will be denied. I would appreciate any assistance with coding this.

Jodi Dibble: thanks for responding - having issues with my scanner, so here's the portion of the Op Report that indicates procedures: ...We were using LigaSure Impact after transecting terminal ileum and the transverse colon distal to the tumor...we brought out the end ileostomy through premarked ostomy site...

So, Surgeon technically did open right colectomy with removal of terminal ileum, but did not perform anastomosis between the remaining ileum and colon. Instead, he brought out the end ileostomy through a premarked ostomy site. The issue is - can I use 44160 even though no anastomosis was performed? Thanks for any assistance you can give me.
 
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lindsey.hansen

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I would code it as a 44160-52 w/ the ileostomy, and if it gets denied I believe just sending in the notes underlining why is sufficient for them to pay. At least that's what we do.
 
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The most appropriate CPT would be 44144 - Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula.
  1. A partial colectomy is when ANY part of the colon is removed and since the terminal ileum is the distal end of the small intestine then 44144 includes transecting the terminal ileum with end ileostomy.
  2. Ileostomies reroute waste products away from damaged or removed areas of a person’s ileum and it would be inappropriate to separately bill 44310 for the ileostomy because the ileostomy is an inherent component of the primary partial colectomy code(s).
Even though there isn't a CCI conflict between 44160 and 44310 the payors are likely to request med recs because 44160 is only reportable when an ileocolostomy (anastomosis between the remaining ileum and colon) is performed. Appending -52 mod because the anastomosis is the primary procedure performed based on the AMA code descriptor.

I know this is a few years after the initial question. But I was searching for the appropriate code for a Rt Hemicolectomy w/end ileostomy which would be coded with 44144 as well.
 

EmilyCavuoti

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The most appropriate CPT would be 44144 - Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula.
  1. A partial colectomy is when ANY part of the colon is removed and since the terminal ileum is the distal end of the small intestine then 44144 includes transecting the terminal ileum with end ileostomy.
  2. Ileostomies reroute waste products away from damaged or removed areas of a person’s ileum and it would be inappropriate to separately bill 44310 for the ileostomy because the ileostomy is an inherent component of the primary partial colectomy code(s).
Even though there isn't a CCI conflict between 44160 and 44310 the payors are likely to request med recs because 44160 is only reportable when an ileocolostomy (anastomosis between the remaining ileum and colon) is performed. Appending -52 mod because the anastomosis is the primary procedure performed based on the AMA code descriptor.

I know this is a few years after the initial question. But I was searching for the appropriate code for a Rt Hemicolectomy w/end ileostomy which would be coded with 44144 as well.
44144 includes creation of a mucofistula. I would not use this code.
 

EmilyCavuoti

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Can you copy and paste the entire surgical portion of the note? I would not use 44144 as that includes creation of a mucofistula which the doctor probably didn't do.
 
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