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Please help...LOST!

  1. #1
    Richardson, TX
    Default Please help...LOST!
    Medical Coding Books
    I have a case that I'm pretty lost on. Not sure what code(s) to capture since my physician normally does not have anything to do with the colon. He is primary on his report and this is what it says he did:

    Once the parathyroid adenoma had been removed, the
    neck was dissected, identifying the stump of the esophagus at the level of the
    pharynx. The previous gastrostomy was taken down, leaving a hole which was
    freshened up in the wall of the stomach anteriorly. This was later used for
    the colon interposition conduit. Once the colon resection for cancer had been
    completed, the transverse colon was further mobilized. A substernal tunnel was
    then constructed from the abdominal incision to the left neck. The strap
    muscles were divided to free this up to avoid any pressure on the colon. At
    this time, the colon was brought through the tunnel in antiperistaltic
    direction only because this appeared to lie better with the middle colic as
    well as the length that was required. The proximal colon was then sewn
    end-to-end to the stump of the esophagopharyngeal junction. This was done in 2
    layers using an inner layer of 3-0 Vicryl running stitch and 3-0 silk
    interrupted sutures. Once this was completed, this was measured for length and
    an end-to-side anastomosis to the stomach was performed in 2 layers once again
    using a running inner 3-0 Vicryl and 3-0 silk interrupted suture, outer layer.
    This proceeded uneventfully. At this time, the gastrostomy was performed in
    the fundus of the stomach using an 18-French Malecot catheter. This was done
    through concentric pursestrings and then tacked to the abdominal wall and
    exited the left upper quadrant. The jejunostomy which had been present had
    been left in place and was not disturbed. Once this had been completed, the
    procedure was turned to closure. Penrose drains were placed and exited from a
    separate stab wound in the neck. A JP was placed down into the thoracic inlet The neck was closed as dictated by Dr. Theilen. The abdomen was closed using
    #1 PDS running stitch with occasional interrupted 0 Nurolon. The subcutaneous
    tissue was closed with 2-0 Vicryl, and the skin with skin clips. A dressing
    was applied. The patient was transported to the Intensive Care Unit in fair

    So I have no idea what the colon interposition is. Would I use 43653 for the gastrostomy?

    There was another surgeon (with a completely different company) he billed; 44140 & 44139. Would I use one of those in addition to the 43653??? Please help! THANK A MILLION for ANY tips or CODES~~
    Julie Graham, BA, CPC, CCC

  2. #2
    The colon interposition code that is close is 43361. Have your physician read the code description to see if this is the correct code for what was done.

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