Partial colectomy was done first (at cecum level) CPT 44204, but in addition to that, small bowel was discovered trapped inside an internal hernia, which was reduced. Do I have to use an unlisted code 44238 in addition to 44204,and should I use 44050 on line # 19 for a reference?
Partial colectomy (Cecectomy), reduction of small bowel volvulus:
Attention was then turned to running of the small intestine which was done from the ligament of Treitz leading to an area of internal hernia formation in the right upper quadrant. This seemed to be secondary to adhesions related to patient's previous cholecystectomy. Adhesions were taken down using the harmonic scalpel. Small bowel was run several times until I was confident that it was freely mobile and not there was no entrapment or volvulus. All small bowel appeared viable. The transverse colon was identified and reflected superiorly and all small bowel was noted to be below the transverse colon and no longer entrapped in the right upper quadrant. The abdominal cavity was irrigated with sterile normal saline.