Results 1 to 3 of 3

Very Weird Case... Need Help

  1. #1
    Default Very Weird Case... Need Help
    Medical Coding Books
    I keep getting these interesting cases this week... and I have never seen this one before!!

    and I need help!

    Here's a clip from the op note:

    Proctoscopy was performed, and a glass coke bottle approximately 7 cm in diameter was noted high in the rectum. With some manipulation from palpating the abdomen as well as with the proctoscope, the bottle was brought down to the rectal vault. However, it was quite tight. Multiple attempts were made to remove the bottle. However, because of the glass, it was quite slippery, and there was a fear of breaking it which would be catastophic. Eventually, this approach was abdanded, and it was decided to perform a laparotomy. Midline infraumbilical incision was made, subcutaneous tissues opened with electrocautery. The peritoneum, which was quite bulky, was also opened with electrocautery. The bottle within the colon was immediately visible. This was slowly pushed distally until it was evacuated from the rectum. Proctoscopy was again performed, and the mucosa found to be intact and no signs of ischemia or perforation. The fascia was closed with a 1 PDS suture. Skin was closed with staples.

    Is the laparotomy the only code I can use?! maybe with a mod 22? actually I would also have to use 79 too....unfortunately he has a history.... LOL
    Last edited by ARCPC9491; 08-28-2008 at 11:54 AM.

  2. #2
    St. Louis, Missouri
    What about 46608 with a 53 modifier. You stated that the first attempt was discontinued because they were afraid of the glass breaking which would have threaten the well being of the patient. I would also bill for the laparotomy.

    Melissa Blow, CPC

  3. #3
    Milwaukee WI
    Default Modifiers
    You state the patient 'has a history..."

    If this is a repeat procto for FB removal within the global for the first procedure then you'd also need a 76 modifier (or -77 if it's a different surgeon) on the 46608, as well as the 53 modifier. You'd use the -76 (or -77)ONLY if it was the exact same CPT code.

    The 79 modifier would go on the laparotomy.

    F Tessa Bartels, CPC

Similar Threads

  1. New Patient Case by Case basis
    By mrsjehu in forum General Discussion
    Replies: 2
    Last Post: 04-15-2015, 05:31 PM
  2. HELP - PV case
    By jlb102780 in forum Cardiology
    Replies: 3
    Last Post: 12-12-2013, 08:21 AM
  3. weird denial against NCCI edits
    By Melissa-ASL-PMB-07 in forum Anesthesia
    Replies: 3
    Last Post: 03-02-2012, 11:57 PM
  4. Weird twin delivery on seperate days!
    By tmerickson in forum OB/GYN
    Replies: 3
    Last Post: 10-06-2011, 04:04 PM
  5. Please help, weird codes!!!
    By HCCCoder in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 10-31-2008, 08:09 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.