# Excision of Lesion on Colostomy Site



## RainyDaze (Oct 7, 2010)

I'm having a hard time trying to figure out how to code this procedure.  The patient has a colostomy and the doctor excised a >1 cm lesion from the colostomy site.  My first thought was 1140X or 1160X depending on the patholoy outcome.  However, Doctor states this was not an excision of skin, it was colon.  

Path reports have not come back yet, so I don't know if this was benign or malignant.    

Any suggestions???

Thanks,

Lori


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## FTessaBartels (Oct 7, 2010)

*Please post the procedure note*

Please post the procedure note. It's hard to tell what code to use without the details.

F Tessa Bartels, CPC, CEMC


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## RainyDaze (Oct 7, 2010)

All he states in the chart is:

Colon mucosal mass in area of colostomy.

>1 cm  lesion excised on colostomy site, colon mucosa.  Closed with running 3-0 vivryl, minimal bleeding observed.


After reading this I asked him about it, and that when he wrote back to me stating that the "tumor was actually on the colon not skin".

Lori


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## marty3073 (Oct 7, 2010)

*colectomy*

Sounds like a colectomy was done, since it was not done on the skin, but on the colon.


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## laston (Oct 7, 2010)

Have you looked at 44110 & 44111?


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## FTessaBartels (Oct 19, 2010)

*Need a full op note*

That's *ALL *he wrote?  Where's the procedure/operative note?

44110 lay description is: The physician removes one or more lesions in the small or large intestine through an incision in the colon (colotomy) or small intestine (enterotomy) without bowel resection. The physician *makes an abdominal incision*. Next, the segment of small intestine or colon containing the lesions is mobilized. An incision is made in the small intestine or colon and the lesions are removed. The enterotomy or colotomy is closed with staples or sutures. The abdominal incision is closed.  (emphasis added by FTB)

If he was able to remove this lesion from the colostomy site itself without any incision into the abdominal cavity this CPT code may not apply.

We really need the full operative/procedure note to know how to code it. I would certainly *NOT* use a major surgery CPT code with only that one sentence in the chart.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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