# I need Help Coding Intestinal Bypass??



## R1CPC (Jul 2, 2009)

My Dr said he did an Intestinal bypass, ileal transverse Colostomy
not sure if thats right. I need help coding this surgery please. 
Report reads

Was prepped and draped in usual sterile fashion. Midline incision was made in the upper abdomen and carried down to the fascia with electrocautery. Four liters of malignant ascites was immediately evacuated. The NG tube was felt to be in stomach. It was then repositioned to maximize its effect. We then eviscerated the small bowel, it was adherent down to the right lower quadrant where the previous ileocolostomy has been performed and the cecum had been removed. I could feel the carcinomatosis into the pelvis and on the small bowel in that area. I extended the incision below the umbilicus in order to provide exposure. It was clear that the previous are of surgery had recurrent carcinomatosis in it and into the pelvic floor, as well as the surrounding bowel. Both the right colon and the distal ileum were covered in carcinomatosis-type metastases. The liver was full of metastases as well. The transverse colon, descending, sigmoid and rectum were free of cancer. The distal ileum approximately 15 cm to 20cm proximal to the obstruction was brought up to the mid transverse colon and a functional end-to-end stapled anastomosis was ceated with the GIA-75 and a TA-60. there was an excellent connection between the small bowel and the mid transverse colon. The small bowel was returned to the abdominal cavity. The fascia was reapproximated with looped PDS. The wound was irrigated, skin was closed with staples and dressings were applied. The patient was extubated and transferred to recovery room in stable condition. 

DX= Small bowel obstruction
DX= colong carcinoma with liver metastases.


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## mjewett (Jul 6, 2009)

What about code 44130? I had a similiar op report come across my desk. After much research, this is what I came up with. 

Melissa-CPC


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## R1CPC (Jul 7, 2009)

Thank you so much


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## mjewett (Jul 8, 2009)

You're welcome :0)


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## R1CPC (Mar 2, 2015)

Hi in looking back at this procedure note I dont think 44130 is correct...does anyone else have an input???


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## cynthiabrown (Mar 3, 2015)

I think 44130 as well....................


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## R1CPC (Mar 4, 2015)

What if this was a laparascopic procedure would we bill 44205? Where i struggle is the physician does not say he created a stoma which I always thought equals the ileostomy??Encoder says for the _ileocolostomy with removal of terminal ileum, the abdomen is deflated and the laparoscope and trocar incisions are closed. The segment of terminal ileum and cecum is removed and an anastomosis is done between the remaining ileum and colon and brought out through the trocar site to an opening created in the skin._ The other issue would 44130 cover a hemicolectomy??


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## mitchellde (Mar 4, 2015)

The original note was written 6 years ago.  The answer may have been the most applicable at that time. We have had 6 years of updates, revision, and additions to the ode set since this time.  To argue this case effectively you will need a 2009 CPT book.


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## R1CPC (Mar 4, 2015)

No the note was not written 6 years a go for some reason it says 2009 on the date posted not sure why it does that. I posted this last month 2/1/2015.


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## cynthiabrown (Mar 4, 2015)

I do not see ectomy in your op note


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## R1CPC (Jan 16, 2019)

I would think that the mention of using a GIA stapler to create and end to end anastomosis between ileum and transverse colon would suffice as an ectomy. In addition, this service does not state that two small bowel areas were connected the op note said the colon and small bowel were connected so I would think perhaps using unlisted code and comparing it to 44160 would be a better rather than 44130.


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