Question Suture of Stoma Perforation

TnRushFan

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Hey folks...I'm stumped and could use some help.

My surgeon performed ileoscopy via a stoma (44380).
Then performed digital stoma exam to reveal 2 perforations of the stoma and sutured them both (not via the scope). ? ? ?
Also debrided necrotizing soft tissue from abdominal wall (11005)
I cannot come up with a CPT code that seems to fit the stoma sutures...maybe just overthinking it IDK.

Note Excerpt:
POST-OP DIAGNOSIS:
Necrotizing soft tissue infection of abdominal wall
Perforation of afferent limb of loop ileostomy
PROCEDURE:
1. Ileoscopy
2. Abdominal wall debridement (48 sq cm)
3. Repair of small bowel perforation

*ileoscopy was performed first via the afferent limb of the end loop ileostomy
*intubation of the efferent limb which was difficult due to the presence of his parastomal hernia
(they do not seem to address the parastomal hernia)
* attempted to take biopsies, however we decided to defer for a future date
***
*then prepped the ostomy and wound cavity site
* Digital evaluation of the end loop ileostomy was evaluated.
*A serosal tear was noted in the afferent limb of the ileostomy which was oversewed
* afferent limb of the ileostomy which yeilded an additional punctate hole in the afferent limb which was also oversewed
* necrotic tissue in the cavity was debrided yeilding a cavity of approximatley 6x4x2cm.
** An area of skin necrosis was debrided as well as an additional area of contamination from the ileostomy site

I was thinking 44602 but they did not make any incisions...they also didn't truly "revise" the stoma so don't think that cpt would fit either.
Thanks in advance for any thoughts on this.
 

nickelclaw

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Peru, IN
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I'm reading it as possibly the serosal tear (punctate hole) was done intraop by the scope so I wouldn't code the repair. As the serosa is a thin tissue and this happens easily.
 
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