Question return to OR colectomy??

tjfrance

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Hi,

I am having a difficult time working this case out. My surgeon is re-opening a laparotomy on a patient that just had a right colectomy (in post op). He goes in and removes the rest of the colon (transverse, descending, sigmoid) down to the rectum and sews that up. He then resects 60cm of small intestine and brings that out as an ileostomy. Any help would be greatly appreciated! I was thinking 44125 for the small intestine resection with enterostomy, but I don't know how to report the "remainder" of the colon being removed with no anastomosis/colostomy etc... since they're just closing the rectum.


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cpc2007

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I would recommend CPT 44150 alone in this case. This code includes removal of the entire colon (dividing the colon at the colorectal junction) and division of the terminal ileum as well. Here because the ileum is ischemic, they take a bit more small intestine on the other side of the ileocolic junction than they normally would, but at the same time, since part of the colon was removed in the prior case, they are taking less colon out than would be typical. At the end of the day, they have removed the entire colon for this patient and created an ileostomy, and when this procedure is performed through an open approach, it is reported with CPT 44150.

I hope that helps - have a great day!

Kim
www.codingmastery.com
 
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