1. T Coop
   Member
   Posted 1 year ago #
   

   Would you please help me with coding this operative note?
   On 8/4/10 patient had a Total Colectomy 44150 he developed an anastomotic Leak with Fistula and Intraabdominal Abscess and had to be carried back to surgery on 8/18/10 for Exploratory Laparotomy with drainage of abscess, End Ileostomy, and Mucus Fistula creation. Surgeon used a loop of small bowel and brought the proximal end up as a matured colostomy and made a mucus fistual with the other end.
   Can you tell me what code you would use for this procedure?
   Thank you for you time in helping me with this coding quetion.

2. apoorba ganguly
   Member
   Posted 1 year ago #
   

   For DOS 08/18/10, I would code like this:

   Dx: 998.59, 998.6
   Px: 44144 - 78 (linked to Dx 2)
   49020 - 59, 78 (linked to Dx 1)

3. T Coop
   Member
   Posted 1 year ago #
   

   Thank you. I talked to the American College of Surgeons coding hotline and they said that they would use the 44144-52-78 because the surgeon is not doing a colon resection but he is doing the Ileostomy and Mucous Fistula and they would use the 49020-59-78. They you so much for helping me.

4. Leesa Israel
   Member
   Posted 1 year ago #
   

   It's interesting to me that ACS suggested that coding. I don't really see how you can report a colon resection without a resection of the colon!

   Seems to me that the better coding would be 49020 or 49060 depending on where the abscess is, along with 44310 for the ileostomy creation. You'd, of course, need to append modifier 78 on both procedure codes since you're in the global of the first surgery.

   I ran this past General Surgery Coding Alert consulting editor Marcella Bucknam, and she agrees. Here's what she says: "Obviously, the ACS feels that the creation of a mucous fistula is more important to the coding than the resection and enough different from a typical ileostomy that is described with code 44310 to justify using a reduced service to try and describe it but I have not seen that in documentation. Also, I think that the combination of modifier 52 and 78 (both of which reduce services) and modifier 59 (which unbundles) screams that the coding may not be right and invites people to play around with your reimbursement." She says that she thinks the coding I mention above "is cleaner and more likely to be paid without question and probably represents a good picture of the service performed."

   Best,
   Leesa

   Leesa A. Israel, CPC, CUC, CMBS
   Executive Editor, The Coding Institute
   leesai@codinginstitute.com

5. T Coop
   Member
   Posted 1 year ago #
   

   Thank you Leesa. Your coding of these procedures seems to be a cleaner way to code this surgery. Thank you for all your help. This Forum has really helped me alot in the couple of months that I have been a member. Have a good day.
   Tersa

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