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  1. User id : 25472 Posted 2 years ago

    HOW WOULD I CODE PROCEDURE "EXPLORATORY LAP WITH SMALL BOWEL RESECTIONS AND ANASTOMOSIS, DRAINAGE OF INTRA ABDOMINAL ABSCESSES, CLOSURE OF FASCIA WITH ABDOMINAL MESH, PLACEMENT OF NEGATIVE PRESSURE DRESSSING 20 X 10 CM., REPAIR OF 2 SMALL BOWEL DESOROLIZATION"?- DX FECALPERITONITIS,ABDOMINAL WOUND EHISCENCE, S/P ILEOTRANSVERSE COLOSTOMY ANASTOMOSIS

  2. SuperCoder Posted 2 years ago

    Hi Kathy.

    I wasn't sure on the coding based on the info provided, so I ran it past general surgery coding expert, Marcella Bucknam to get her thoughts. Here's what she had to say:

    "This is not enough information to fully choose codes. Here is what I can tell you. By the way, I’m going to assume that exploratory lap is exploratory laparotomy, not exploratory laparoscopy but if this was performed through a scope that would change all of the coding.

    44120 (unless this was resection and anastomosis of the colostomy site)
    44121 for each additional resection with anastomosis (don’t know how many were done)

    There are a number of codes for open drainage of abscess in 49020 – 49060 depending on where the abscesses are
    Closure is always bundled unless there was some special advancement flap or skin graft, etc. Use of mesh is not separately billable, negative pressure dressing is not typically separately billable when performed in conjunction with a surgical procedure but the code would be 97606.

    Repair of desorolization is 44603 but desorolization wounds are often complications of the other procedures described above and I would not bill this unless it was clear that it was unrelated to the previous procedure or that the wounds were unavoidable because of the patient’s condition.

    I am not assigning diagnosis codes because it is not clear to me from this if these are complications of the colostomy or complications of the previous procedure or problems related to the reason the patient previously had a colectomy or what is going on. I think there will need to be some documentation about why all of this is addressed to the small intestines when all of the diagnoses seem to be about the abdominal wall and/or colon.

    Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-I, CCC, COBGC"

    I hope Marcella's comments help point you in the right direction.
    Best,
    Leesa

    Leesa A. Israel, CPC, CUC, CMBS
    Executive Editor, The Coding Institute

About this Question

  • Posted by 25472, 2 years ago. There are 2 posts. The latest reply is from SuperCoder.