# Reversal of loop ileostomy, extensive lysis of adhesions and repair of peristomal her



## tboback (May 2, 2013)

Need help coding this procedure:

PROCEDURE IN DETAIL: The patient was subsequently taken to the OR, placed
on OR table in supine position. Bilateral SCDs were placed. Anesthesia
was induced. The patient was intubated. Foley catheter was inserted. 
Abdomen was prepped and draped in sterile techniques. Using a 10-blade
scalpel, parastomal skin incision was made. This was extended into the
subcutaneous fat. The patient was found to have a large parastomal hernia
with extensive, dense small bowel adhesions. These adhesions were
carefully taken down using a combination of sharp and blunt dissection. 
Once ileostomy was completely mobilized and free of all the adhesions,
linear GIA stapler was fired proximal and distal to the loop ileostomy. 
The mesentery to this segment of the bowel was divided with a LigaSure,
and the specimen was removed from the field. Small enterotomies were then
made in the 2 limbs of small bowel, and a side-to-side enteroenterostomy
was created with linear 75 GIA stapler. Enterotomy was then closed with a
TA 60 stapler. Staple line was reinforced with interrupted 3-0 silk
stitches. Mesenteric defect was then closed with running 2-0 silk. The
anastomosis was introduced back into peritoneal cavity. The fascial layer
was reapproximated with #1 running Prolene stitch. The wound cavity was
then irrigated. A 0.25 inch Penrose drain was placed in the incision, and
the wound was then closed with a stapling device. Dressing was applied,
anesthesia withdrawn. The patient was extubated and transferred on
stretcher to recovery room. The patient tolerated the procedure well. 
There were no complications

We think 44314 will cover the loop ileostomy and adhesions. However what code should be used for the "repair of the peristomal hernia"?

Need your help!


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## TS4971 (May 2, 2013)

You would have to use 44799 unlisted procedure, intestine.


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## ddavis (May 2, 2013)

your note says Reversal not Revison ( I don't see where they created a new stoma)  the code for reversal is 44625.   If there was extensive LOA-the physician  needs to dictate addendum for time spent in order to bill  for mod 22.   

44005-LOA  is separate procedure.  (included in)
44346 paracolostomy hernia (stomal) is also separate procedure.  (included in).

The only thing I see you can bill for at this point  is the Reversal  code 44625.   If the physician goes back and dictates specifically how much time was spent on the LOA-you might be able to billl for the LOA (if it's greater than 1 hr) with a mod 22 attached.


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