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Laparotomy sigmoid - I hope someone can assist

  1. #1
    Default Laparotomy sigmoid - I hope someone can assist
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    Good morning,
    I hope someone can assist with this one. I was looking at 44320 for the Colostomy, but the Dr. did a mesh reinforcement a Sugar Baker Tech. and he said there is a code for that procedure. Any ideas?

    PROCEDURE PERFORMED: Laparotomy with diverting end sigmoid colostomy and
    biologic mesh reinforcement of stoma site (Sugar Baker technique).
    Closure of enterotomy.

    PROCEDURE IN DETAIL: Patient was taken to the operative suite and placed in
    the supine position and after adequate general endotracheal anesthesia, the
    patient's abdomen was prepped and draped in a sterile fashion and a Foley
    catheter was placed. An incision was made from the umbilicus down to the
    pubis, carried down through all layers with cautery. The peritoneum was
    elevated in size. There were dense adhesions underneath the peritoneum.
    These were lysed with sharp dissection. An enterotomy was made at superior
    aspect of the wound. There was minimal if any spillage. The area was
    oversewn with 3-0 PDS pop-offs in Lembert fashion. A clear pocket was located
    in the left lower abdomen at which point the colon was then dissected clear
    laterally and medially. A Contour stapler was then used to divide the distal
    aspect of the sigmoid colon, and the mesentery was divided further using 2
    firings of the Echelon 45 stapler avascular load.
    The enlarged epiploicae near the actual stoma itself were removed with
    cautery. At this point an incision was made in the left abdomen where the
    enterostomal nurse had marked the patient preoperatively and once a circle of
    skin was removed, the dissection was carried down through the fascia in
    cruciate manner. This admitted 2 gloved fingers
    full-thickness through the rectus sheath. The stoma was brought out through
    this with some manipulation and then left-tagged with a Babcock. The bowel
    as it reached the stoma was then laid flush against the anterior abdominal
    wall and a piece of status mesh 16 x 20 was then selected. It was then rinsed
    on the back table, brought up to the field. It was placed within the wound
    so that the bowel entered in the left paracolic gutter and there was complete
    coverage of where the bowel actually went through the defect in the rectus
    sheath. This was tacked in place with ProTacks on either side of the bowel
    and then on both lateral margins of the mesh. The part that draped over the
    anterior midline was then left for closure with the general abdominal
    closure. There appeared to be no ongoing bleeding at this point. The bowel
    appeared pink and healthy. The fascia was then closed in the midline with a
    running 0-looped PDS with a bite incorporating some of the status mesh in the
    midline. The skin was then closed with staples. This portion of the wound
    was isolated. The colostomy was then matured in the usual manner using 3-0
    Monocryl after which an appliance was placed and then dry dressings were
    placed on the wound. Patient tolerated the procedure well. She was taken to
    the recovery room, extubated in satisfactory condition.

  2. #2
    I don't know what code you could use since this is mesh placed for prevention of parastomal (incisional) hernia, not for treatment of the hernia

  3. #3
    I think that would be viewed as incidental to the procedure.

  4. #4
    That's the problem with prophylactically putting mesh/biologic for the prevention of parastomal hernia. You can't code for fixing the hernia since there isn't one. And apparently the application of biologic codes are only intended for skin uses so they're not appropriate either. And that's a lot of extra work to do for something to be labeled incidental to the procedure. So he's probably out of luck.

  5. #5
    Thank you so much. That was my thought also, but the Dr. thinks we should be able to bill for it.

  6. #6
    I'm sure he thinks he should be able to bill for it. Afterall, 16 x 20 is a huge piece of mesh and that probably took alot of time to place. I just haven't been able to figure out how to bill for it. You can bet if the company reps don't know how to bill for it, then it probably can't be billed yet.

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