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Code-CPT code for Resection

  1. #1
    Location
    Long Island/New York
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    1,271
    Default Code-CPT code for Resection
    Medical Coding Books
    looking for a CPT code for Resection of terminal Ilieum (performed during Hatman procedure). Thanks..

  2. #2
    Location
    Greater Orlando
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    146
    Default Hartman type procedure
    CPT lists two codes, one of which should meet your needs:
    • 44143 Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)
    • 44206 Laproscopy, colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure)
    Since the partial colectomy is the greater procedure and the resection of the terminal ilieum is the lesser, I would argue that the latter is included in the former and is not separately billable, particularly since the resection was performed in the same session as the partial colectomy.

    In layman's terms, I'd say they were already in there and whacked off another wee bit, so, not a lot of additional work.
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

  3. #3
    Default
    Please post the op note. I don't think Ron has answered your question. But, without seeing the op note, I'm betting on 44160 as the code you're asking for.

  4. #4
    Location
    Greater Orlando
    Posts
    146
    Default
    Colorrectal Surgeon,

    Arrrggghhh! (quoting Wiley of B.C.)

    Thanks, that looks like the better choice. Now to see what the op note has to tell us.

    Thanks,
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

  5. #5
    Location
    Greater Orlando
    Posts
    146
    Default
    Quote Originally Posted by colorectal surgeon View Post
    Please post the op note. I don't think Ron has answered your question. But, without seeing the op note, I'm betting on 44160 as the code you're asking for.
    44160 sounds good because it references the terminal ileum, however, it describes a different procedure and that one fails to mention performing a Hartman type procedure. So, I'm not yet convinced that it is likely the proper code.

    Ingenix 2011 Coders' Desk Reference: Procedures 'lay description' for CPT 44160 is:
    The physician makes an abdominal incision and removes a segment of the colon and terminal ileum and perforrms an anastomosis between the remaining ileum and colon. The physician makes an abdominal incision. Next, the selected segment of colon and terminal ileum are isolated and divided proximal and distal to the remainng bowel and removed. An anastomosis is created between the distal ileum and remaining colon with staples or sutures. The incision is closed. (p.408)
    In contrast, the CDR's 'lay description' for CPT 44143 reads:
    The physician resects a segment of colon and brings the proximal end of colon throught the abdominal wall onto the skin as a colostomy. The physician makes an abdominal incision. Next, the selected segment of colon and terminal ileum are isolated and divided proximally and distally to the remainng bowel and removed. The proximal end of colon is brought through a separate incision on the abdominal wall onto the skin as a colostomy. The distal end of colon is closed with staples or sutures and left in the abdomen. The initial incision is closed.
    In 44160, there is no mention of the physician creating a colostomy (or ileostomy, since it's the ileum being brought out), nor is there mention of closing the distal end of colon with staples or sutures and leaving it in the abdomen.

    Thus, 44160 appears to not fit the facts we've been given so far.
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

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