I agree w/ the 44310. For the colon, it would depend on whether the doctor you're billing for did the first surgery and what was billed then. It looks as though a partial colectomy was done and the ends were "clipped and dropped" to be dealt with at the 2nd look laparotomy (this one). If a 44140 was billed for the first surgery, then the anastomosis @ the 2nd surgery was included and nothing is billed for it now. When I have a case like that, if no other separately billable procedures take place, I just bill the 49002 for the 2nd op. If, like this one, you have another billable procedure (the ileostomy), then I bill that and not the 49002. If your doc didn't do the first surgery it gets more complicated, and might come under the 44130 for both (anastomosis of intestine, with or without cutaneous enterostomy), but if you have to use that, I'd go for a -22 modifier in this case.
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