sacook
Contributor
44 year old patient 3 day post cesarean for premature twins. During cesarean section an injury occurred to the sigmoid colon resulting in fecal peritonitis. During first laparotomy colorrhaphy was preformed during more than 2 hours of enterolysis. Wound VAC was placed and staged laparotomy was planned in a few days. Two days later patient was taken back to OR. During 3 hour procedure of additional enterolysis and examination the sigmoid colon was mobilized off the bladder and uterus. Thorough examination of the sigmoid colon revealed that the previous repair appeared tenuous. It was decided to perform sigmoid colectomy of this region and Hartman's procedure with end colostomy. The rectum remained densely adherent to the posterior wall of the bladder. The Doctor states, I was able to transect the rectum at the sigmoid rectal junction with a GIA 70 mm stapler with green staple cartridge. I tagged the rectum with 2-0 Prolene suture. This was about 3 cm above the uterus. I then transected the sigmoid colon just proximal to the previous colporrhaphy also with the GIA 70 mm stapler. The descending colon was placed into the left paracolic gutter, extensive and thorough irrigation of the abdominal cavity was performed. Wound VAC was placed and fascia was loosely closed with staged procedure planned in 48 hours. Two day later the colostomy was preformed.
How would I bill the colectomy on one day and the colostomy on another. I don't see separate codes. Would I use 44140 on the first day even though no anastomosis was done and 44143 on the subsequent day? Would I use a 58 modifier on both procedures?
I greatly appreciate any suggestion anyone can offer.
How would I bill the colectomy on one day and the colostomy on another. I don't see separate codes. Would I use 44140 on the first day even though no anastomosis was done and 44143 on the subsequent day? Would I use a 58 modifier on both procedures?
I greatly appreciate any suggestion anyone can offer.