Wiki Incomplete Colectomy


Garland, KS
Best answers
My provider attempted to perform a Lap Partial Colectomy with end colostomy- 44206. They also performed over 90 minutes of adhesion removal and a take-down of the splenic flexure. However, when they went to do the colectomy, the disease was too active and they decided to not do it, and no anastomosis was completed. They did perform the end colostomy.

How would you report this? I am having trouble deciding between a modifier 52 for a reduced procedure but also somehow compensating for the adhesion removal with a modifier 22.

Below is the operative report. Any insight would be wonderful. CPT:44206 (MOD 22 or 52?) 44213

“The entire abdomen was inspected for peritoneal implants or other concerning findings; none were found. There were significant adhesions in the left pelvis, consistent with his chronic perforation and inflammatory process. There were also adhesions in the right pelvis, which were more filmy and easily taken down with the harmonic scalpel. In the left pelvis, the sigmoid colon was mobilized gently from its lateral attachments. Care was taken to avoid vessels and the ureter was identified and protected. Mobilization continued cephalad, towards the splenic flexure. The patient was placed in reverse Trendelenburg with rotation to the right aid in the exposure. The splenocolic ligaments were taken down with the Harmonic scalpel, avoiding splenic vessels. There was some evidence of distal descending colon diverticulosis, but the entirety of the transverse colon, splenic flexure, and descending colon were soft and mobile after the dissection. Attention was returned to the pelvis. The distal sigmoid was very adherent to the pelvic sidewall, where a tiny bit of residual inflammation/evidence of his chronic perforation were noted. Attempt was made to cautiously and bluntly dissect the rectosigmoid, however it was very adherent in all directions and still quite inflamed. Decision was made that the inflammatory process was still too active to make a reliable colorectal anastomosis. Thus, a diverting temporary colostomy was created. ICG was injected to examine for watershed areas; while the colon was perfused, it did not have excellent perfusion in the area where an anastomosis would likely be created. Again, the decision was for end colostomy. A port was up-sized in the RLQ to accommodate a 12 mm port for a laparoscopic blue-load stapler. The colon was stapled across, approximately 3-6 cm proximal to the badly inflamed rectosigmoid. The mesentery was taken down with the harmonic. A laparoscopic Babcock was placed on the staple line. Extracorporeally, an incision in the left mid quadrant was made with cautery. All skin incisions were closed with buried 4-0 Monocryl sutures and covered with steri-strips and sterile towel. The colon was delivered through the abdominal wall, allowing approximately 3-fingers of stretch in the fascia to pass the colon. The stoma was matured in 4 quadrants with chromic gut, and remaining circumference with Vicryl sutures. A stoma appliance was placed.


Impressive amount of persistent inflammation in the rectosigmoid/rectum; anastomosis was not felt prudent. Splenic flexure completely mobilized without incident. “
I am thinking no mod needed 44206 since no extra time was noted for adhesions no 22

Hartmann procedure

44143 Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)

44206 Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure)

The lower part of the sigmoid colon and/or the upper part of the rectum is excised. The descending colon is manipulated and sutured to the skin to create a colostomy. The proximal end of the descending colon is oversewn and a pouch is formed.

In 44206, the new proximal end of the colon is brought through an opening made in the abdominal wall and anastomosed so as to exit onto the skin for a colostomy and the remaining distal end is closed off. In 44207, after the distal segment of diseased colon and/or rectal tissue is resected, the new ends are brought together and an anastomosis is done between the colon and the rectum low in the pelvis with staples or sutures (coloproctostomy). The abdominal cavity is inspected through the laparoscope for hemostasis and irrigated. The instruments are removed and the remaining abdominal wounds are closed.