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Dear Doctor: At breakfast this morning, my intestines fell out and landed in my eggs.

  1. Exclamation Dear Doctor: At breakfast this morning, my intestines fell out and landed in my eggs.
    Medical Coding Books
    This patient has a hemicolectomy 3 weeks ago (by another physician in another state), and this morning during breakfast, he had a coughing fit, during which the incision burst open. 10 inches of jejunum and a large portion of omentum are now protruding from the open incision.

    During surgery, a small tear is discovered in one portion of the jejunum, which was apparently accidentally sutured to the incision when the incision was closed. There is no obvious contamination of the abdominal cavity, so the tear is repaired and the intestines are put back where they belong, and the abdomen is closed again.

    How does one go about coding this? Am I going to have to use an unlisted procedure code? And if I DO have to use an unlisted procedure code, how do you establish an appropriate fee?

  2. #2
    Quincy, MA
    Lovely visual!

    Would one of these help?:

    49900...suture, secondary, of abdominal wall for evisceration or dehiscence.


    44602...suture of small intestine
    Leanne, CPC
    General/Vascular Surgery

  3. #3
    I just read this at lunch....bad timing. This seems pretty extensive.
    What about 49999 as well, repair of omentum.
    adrianne, cpc

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