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need help coding colon surgical procedure

  1. #1
    Question need help coding colon surgical procedure
    Medical Coding Books
    1. subtotal colectomy basically removing right colon and transverse colon
    2. Extensive lysis of adhesions
    3. Rapair of 2 iatrogenic small bowel injuries
    4. Ileocolic side to side anastomosis

    the abdomen was entered, extensive lysis of adhesions performed between small bowel omentum to anterior abdominal wall.
    The patient has descending end ostomy in left side of abdomen, liver normal, gallbladder absent, pancreas and retroperitoneum normal, extensive adhesions involving small bowel to ligament of Treitz to terminal ileum. In process of lysis of adhesions 2 enterotomies were created mid jejunum and mid small bowel. They were repaired.
    The right colon was mobilized and the transverse colon was mobilized. The splenic flexure was not mobilized. The patient has end ostomy on left side of body and incision was made in skin and ostomy was dissected off abdominal wall then delivered back into the abdomen and mobilized.
    the patient has a segement of left colon attached to the rectum from previous surgery, measuring about 1 foot long. The mesentery to the transvers colon, splenic flexure and right colon was taken down close to the bowel in order to prevent damage to marginal artery. The blood supply to the specimen in the right colon specimen was removed and opened and examined.
    After this procedure was done, a sis to side terminal ileum to left colon asastomosis was performed, the mesentery defect was closed. The abdomen was washed out, counts were correct, no bleeding, anastomosis was secure, the enterotomies were secure, the bowel was laid down, not twisted, the abdominal wall defect from the ostomy was closed. the abdominal fascia was closed, skin left open and packed.

  2. #2
    Location
    Springfield, Missouri
    Posts
    52
    Default
    I would look at 44140....I would not code the small bowel repair. The lysis will be 44005, however check your CCI edits, because the lysis is usually bundled with everything. The anastomosis is included in the colectomy. Hope this helps

  3. #3
    Location
    Springfield, Missouri
    Posts
    52
    Default
    Let me explain the repair, since this was done due to the adhesions, I would not code this out separate, since it appears from the note it was caused by the adhesions.

  4. Default Coder
    This looks like a takedown of a colostomy therefore, I would code it as 44626.

  5. Default
    Definitely a take down of colostomy but there isn't a take down code that includes ileo-colo anastomosis. I think 44160 would be more appropriate. That will included the partial colectomy and the ileocolostomy.

    You could try this scenario:
    44160 -22 for extensive lysing
    44603 -59 w/ 998.2
    44139

  6. #6
    Default
    Can somebody explain what is the term "take down colostomy"

    Thank you

  7. Default
    OpNote states: "The patient has descending end ostomy in left side of abdomen". Dr removed/took down the end ostomy, did partial colon resection and created a Ileocolostomy ("terminal ileum to left colon asastomosis was performed").

  8. #8
    Location
    Springfield Mo AAPC
    Posts
    22
    Default
    44626 - Dr. is taking down the colostomy, just means closing the colostomy site and hooking the colon back up, he refreshes the colon edges before putting them back together, the resection is included, cannot bill for it separately.

  9. #9
    Default
    Thanks to everyone for the help!

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