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Thread: Very Weird Case... Need Help

  1. #1

    Default Very Weird Case... Need Help

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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
    Join Date
    Apr 2007
    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

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