# Ileocecal Resection



## tcooper@tupelosurgery.com (Mar 21, 2013)

Good Afternoon. Would someone help me with this coding problem please?
Patient was in a Motor Vehicle Accident where he had a small bowel eviscerated from the right midabdominal area where he had a puncture wound. Patient had a through-and-through injury to the cecum. Surgeon performed an anastamosis between the small bowel and the ascending colon. Once this was done he wrapped this in omentum and placed omentum down into the retroperitoneal area.
What code do you think would appropitate for this procedure. Thank you in advance for your help.
Teresa Cooper, CGSC


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## CarolinaSunshine (Mar 22, 2013)

Look at 44160 for the ileocecal resection (ileocecectomy) 
Description:  The physician makes an abdominal incision and removes a segment of the colon and terminal ileum and performs an anastomosis between the remaining ileum and colon. The physician makes an abdominal incision. Next, the selected segment of colon and terminal ileum are isolated and divided proximal and distal to the remaining bowel and removed. An anastomosis is created between the distal ileum and remaining colon with staples or sutures. The incision is closed.
I'm not sure about the omental procedure without reading the op note.  If the physician did an "omental flap", you can use +49905.  These are normally done with stomach procedures, duodenum procedures, or to protect an intestinal anastomosis.  It is also known as a "graham patch".  However,  physicians pull omentum down over the intestinal area after procedures normally, so there would be no charge for this.  In order to perform an "omental flap"--he needs to go into detail about how this was done.  The description of the procedure is:  The omentum is dissected from the transverse colon from left to right and small vessels are ligated. When completely separated from the transverse colon, the omentum is dissected from the stomach with careful clamping, division, and ligation of vessels. The omentum is fully mobilized and pedicled on the right or left gastroepiploic vessel, depending on the purpose. More incisions and tunneling may be necessary to bring the flap into its new location to fill a defect. 
If he doesn't go into this detail, I would not charge for this portion.  It would be included in the 44160.


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