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Wiki Interesting case;need help

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lromero

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15
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Houston, TX
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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.
Thanks
 
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.......
C.Martin, CPC-GENSG
 
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