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Interesting case;need help


Houston, TX
Best answers
All expertise needed for following case:
Surgeon took 6 hrs for this case:

Pre-op Dx: Prior colostomy 2ndary to perforated sigmoid colon
Postop Dx:1:prior colostomy 2ndary to perforated sigmoid colon
2:Extensive adhesions involving small bowel,anterior abdominal wall, small bowel & omentum & large bowel, bladder,vaginal cuff, Hartmann's puch.

Procedure: Exploratory laparotomy
Extensive lysis of adhesions
Small bowel resection including previous colostomy
Takedown of splenic flexure & new decending colostomy

We are submitted w/mod-22 w/copy of op-report because of the length of time.
Still working on the coding, but will take advise from the experts, since I'm still new with this specialty.


Best answers
I think I'm missing something - how could a small bowel resection include the prior colostomy? Had to be a partial colectomy didn't there? I'm afraid there are too many possibilities here to give a definitive opinion, but I would look at 44141, 44143, & 44144, to any of which you could add 44139 for the splenic flexure, or 44345, which could NOT take the 44139. This is also assuming that there were no anastomoses anywhere.......