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Priyanka Posted Mon 11th of December, 2017 12:29:59 PM
Patient had massive distention of the entire colon as well as small bowel distention. Both the inferior aspect of the cecum and the terminal ileum approximately 15 cm upstream from the ileocecal valve were involved in a firm inflammatory or malignant mass associated with the sigmoid colon and posterior superior wall of the bladder. An en bloc resection was performed. This did not require a cystectomy as we were able to resect the lesion removing the posterior bladder peritoneum. Both ureters were identified and protected. This was a very difficult operation given the firm mass tethering massively distended bowel down into the pelvis and obscuring visualization and exposure of the ureters and mesentery. The operation required at least twice the typical time necessary for a colectomy. Due to the unusual difficulty and time requirements a modifier 22 is appropriately submitted for this operation.
SuperCoder Answered Tue 12th of December, 2017 05:52:35 AM

Hi,

 

Please note that you have not mentioned your question. If it is regarding usage of modifier 22, then our answer is: yes, your documentation is sufficient to support usage of modifier 22.

 

Thanks.

Priyanka Posted Tue 12th of December, 2017 06:09:37 AM
I apologize! how would I code this if there is no anastomosis. the provider did 2 resections and s ostomies. he is wanting to use 44143 and 44160 apply modifier 22 to 44143.
SuperCoder Answered Wed 13th of December, 2017 06:14:10 AM

Thanks for your question. Please find answer below:

 

For sigmoid colectomy and end colostomy, the CPT code would be 44143 and for ileocecectomy with end ileostomy, the appropriate code would be 44143. There is CCI edit between these 2 codes. So, you may report both codes together and append modifier 59 with code 44160.

 

Regarding anastomosis, please note that doctor cannot leave the two cut ends suspended without joining them (i.e. anastomosis). So, please read your documentation carefully. If there is anything questionable, please confirm with the clinic or the doctor.

 

Please feel free to write if you have any questions.

 

Thanks.

Priyanka Posted Wed 13th of December, 2017 09:38:23 AM
thank you! would I still use modifier 22? and I asked the doctor about the anastomosis, he said no anastomosis. I found it odd too.
SuperCoder Answered Thu 14th of December, 2017 01:25:03 AM

Hi Priyanka,

 

Thanks for providing more information. Please find below resolution to your query.

 

Yes, usage of modifier 22 is justified by the documentation. Anastomosis:- it is not possible that physician did not perform any anastomosis. Please check Medical Record and search for the keywords like “ileum and cecum were sewed, joined, or sutured”, “ileocolostomy”, or “ileocecostomy” etc. All these mean “anastomosis” of ileum and cecum after resection.

 

Thanks.

 

Priyanka Posted Thu 14th of December, 2017 08:26:33 AM
thank you!
SuperCoder Answered Thu 14th of December, 2017 23:29:36 PM

Your welcome!

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