AAPC - Back to school
Results 1 to 2 of 2

Thread: Subtotal colectomy with VAC PAC

  1. #1
    Join Date
    Apr 2007
    Lehigh Valley

    Default Subtotal colectomy with VAC PAC

    AAPC: Back to School
    Dr. performed a subtotal colectomy with placement of VAC-PAC. New surgery for me to code and not sure which one to use.

    PT had ischemic bowel. Exploration revealed the patient's left colon to be dead including sigmoid colon and upper rectum as well as the splenic flexure up to about mid to distal transverse, which looked healthier. Cecum was also ischemic appearing and did not appear viable. Subtotal colectomy was decided upon.

    Cecum was mobilized and the terminal ileum was taken down with electrocautery. We then took down the white line of Toldt on the right side, completely mobilizing the colon up to the hepatic flexure. A window was then created in the mesentery of the terminal ileum. A GIA100 was used to transect the terminal ileum. The Ligasure impact was then used to take down the entire mesentery of the right colon. Omentum was taken off the transverse colon and the transverse colon was completely mobilized off of stomach and duodenum. Splenic flexure was able to be mobilized w/o injury to the spleen or surrounding structures. Sigmoid colon was taken off its retroperitoneal attachments. Upper aspect of rectum was noted to be necrotic and we had to dissect down to about the mid rectum in order to obtain a more viable distal margin. We then took down part of the mesorectum close to our specimen in an attempt to get as low as possible, again to reach viable bowel. Once this was performed, the area was skeletonized and a window made in the mesentery. EndoGIA stapler was used to transect the rectum. The entire specimen was handed off. Abdomen was irrigated with copiuos amounts of saline. We inspected our rectal staple line and saw that is appeared intact and this tissue was viable. Decision was made to place a trauma VAC PAC in the patient's abdomen and be hooked up to suction for a second look in 24-48 hours, once the patient stabilized.

    I found 44150 and 44145. Not sure if this is correct or not due to the VAC being placed. Would I also use 44139?
    Thanks for your help!

  2. #2
    Join Date
    Apr 2007


    what did they do the distal end of the ileum? If that was brought out as an ileostomy, your code would be 44150 or 44155 depending on if all of the rectum were removed. mobilization of splenic flexure is not a PX for 44150,or 44155 it is assumed that its taken down with a total colectomy. As for your vac placement, see 97605. Ive worked in some facilities that does report it in the OR and some that does not.

    Hope that helps
    Last edited by surgonc87; 03-11-2011 at 01:13 PM.

Similar Threads

  1. Cpt Code S/P subtotal colectomy
    By cgmarianna in forum Gastroenterology
    Replies: 1
    Last Post: 04-16-2013, 11:41 AM
  2. Subtotal Colectomy with ileostomy - Help
    By RainyDaze in forum General Surgery
    Replies: 2
    Last Post: 01-04-2012, 02:50 PM
  3. subtotal colectomy with end ileostomy
    By dovejsd in forum General Surgery
    Replies: 4
    Last Post: 02-28-2011, 09:42 AM
  4. How do you bill for subtotal colectomy
    By dsenger in forum General Surgery
    Replies: 2
    Last Post: 09-21-2010, 05:31 PM
  5. Subtotal Colectomy
    By MEZIESKY in forum Gastroenterology
    Replies: 1
    Last Post: 05-04-2010, 09:07 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.