# Need Help on Colotomy



## hcg (Aug 6, 2014)

Hello Everyone,

I need enlightenment on repair of accidental colotomy. Patient had colon resection from colon cancer. After 49 days patient was admitted to the hospital because of ventral incisional hernia. My Dr. sent patient back to OR for hernia repair, only to find out that there was colotomy in the colon. Dr. repaired colotomy and didn't proceed to hernia repair. someone told me, you don't bill repair of colotomy from previous surgery. But I need proof. Is there any article or information that you can share regarding this?

Thank you so much for your help.


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## TWinsor (Aug 7, 2014)

According to the CCI guidelines if the laceration and/or puncture is caused by the physician during the procedure, repair is not billable.  If this was 49 days later I would think you could bill the repair, maybe with a 58 modifier if your physician performed the colon resection.  Just my thought......


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## cynthiabrown (Aug 7, 2014)

I would think a 78 modifier


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## hcg (Aug 7, 2014)

TWinsor said:


> According to the CCI guidelines if the laceration and/or puncture is caused by the physician during the procedure, repair is not billable.  If this was 49 days later I would think you could bill the repair, maybe with a 58 modifier if your physician performed the colon resection.  Just my thought......



Thank you for the information. If I have to bill the repair, then what could be the CPT code for the the repair? Here's the op report:

**********************************************************


PREOPERATIVE DIAGNOSIS: Ventral incisional hernia.
POSTOPERATIVE DIAGNOSIS: Apparent benign prostatic hypertrophy with urinary retention. Ventral
hernia. Accidental colotomy.
SURGEON: Dr. M
ASSISTANT: F. L, SA.
ANESTHESIOLOGIST:
ANESTHESIA: General.
OPERATION: Laparotomy with repair of accidental colotomy.

ESTIMATED BLOOD LOSS
Minimal.

INDICATIONS
The patient is 78-year-old with a previous history of colon resection for cancer. Pt has a symptomatic ventral hernia. We offered repair. Risks including bleeding, infection, injury to intra-abdominal organs, conversion to an open procedure, as well as risks of anesthesia, were discussed with the patient.

DESCRIPTION OF PROCEDURE
The patient was identified, received intravenous Ancef preoperatively and was brought to the operating room and placed in the supine position. General endotracheal anesthesia was administered. Foley catheter was passed with modest difficulties. Then 1200 mL of urine was evacuated from the bladder, suggesting urinary retention complicating benign prostatic hypertrophy. The abdomen was prepped with ChloraPrep and appropriately draped. A transverse incision was made in the right upper quadrant just below the costal margin. Subcutaneous dissection was performed. Individual layers of the abdominal musculature were sequentially incised to gain access to peritoneal cavity. Hassan trocar was passed into the abdominal cavity and tacked to the external oblique fascia with 0 Vicryl. Insufflation with carbon dioxide was instituted. Inspection with the laparoscope suggested feculent
material.

The Hassan trocar was removed. The wound was enlarged and explored, and revealed apparent injury to the right colon. This injury was mobilized up into the wound. Inspection revealed small punctate 1.5 cm defect in the colon. Colotomy was repaired in 2 layers of interrupted 3 - 0 silks, first layer
full thickness, second layer Lembert sutures.

The wound was irrigated with saline. The peritoneum was reapproximated with running 3-0 Vicryl. Internal and external oblique fascia were closed separately with running 0 Vicryl suture. The wound was again irrigated saline. The skin was loosely stapled shut, and moist gauze was packed into the wound. Then the procedure was terminated. The patient tolerated the procedure without hemodynamic compromise.

Thank you for your help


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## hcg (Aug 7, 2014)

cynthiabrown said:


> I would think a 78 modifier



Thank you. I would go for 78 since it is staged related but unplanned.


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## TWinsor (Aug 11, 2014)

The op report reads as if the colon puncture was during this surgery not left from the prior colon resection. 

If this is the case, you can only bill for the exploratory lap since the surgeon created the puncture you cannot bill for the repair. 

HTH!


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## hcg (Aug 11, 2014)

TWinsor said:


> The op report reads as if the colon puncture was during this surgery not left from the prior colon resection.
> 
> If this is the case, you can only bill for the exploratory lap since the surgeon created the puncture you cannot bill for the repair.
> 
> HTH!





Ok, thank you very much. I appreciate the help


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## hcg (Aug 13, 2014)

TWinsor said:


> The op report reads as if the colon puncture was during this surgery not left from the prior colon resection.
> 
> If this is the case, you can only bill for the exploratory lap since the surgeon created the puncture you cannot bill for the repair.
> 
> HTH!




Out of curiosity, if this punctured was beyond global period, what code can I use for the repair?


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