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Need help w/ complicated 2 day case

  1. #1
    Question Need help w/ complicated 2 day case
    Medical Coding Books
    I would appreciate any help with this complicated bowel case. On 1st day pt. taken to OR for Exp. Lap,release of internal hernia, small bowel resection for ischemic bowel (not anastomosed until 2nd day), extensive (>45mins) lysis of adhesions, 12 liter peritoneal lavage. Planned to bring this pt. back next day to see if anastomosis of bowel could be done along with abdominal washout.

    2nd day doc reopened pt. completed the small bowel anastomosis, repair of serosal tear along with washout.

    I'd like to append 22 modifier to Day 1 but if I bill the 44120 I would have to append the 52 since he didn't complete the anastomosis. all else seems inclusive so it really needs to be submitted with the 22.
    Day 2 - would that be 44130-58?

    Not sure how to report these 2 cases. Anyone have any ideas?

  2. #2
    Location
    Johnson City
    Posts
    202
    Default
    On Day one did your doctor bring the bowel out skin level for ostomy? Or leave the belly open with a wound vac?
    Melissa Jewett, CPC

  3. #3
    Default
    He loosely closed the abdomen and applied the vac, left the small bowel ends just stapled off knowing he was coming in the next day to anastomosis if all was viable.

  4. #4
    Location
    Johnson City
    Posts
    202
    Default
    In that case it sounds like you coded it perfectly
    Day one 44120-52 b/c not anastomosed, and 22 b/c unusal cicumstances
    Day two 44130-58
    Melissa Jewett, CPC

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