# need help coding colon surgical procedure



## MSUEEMBRY (Dec 14, 2011)

1. subtotal colectomy basically removing right colon and transverse colon
2. Extensive lysis of adhesions
3. Rapair of 2 iatrogenic small bowel injuries
4. Ileocolic side to side anastomosis

the abdomen was entered, extensive lysis of adhesions performed between small bowel omentum to anterior abdominal wall.
The patient has descending end ostomy in left side of abdomen, liver normal, gallbladder absent, pancreas and retroperitoneum normal, extensive adhesions involving small bowel to ligament of Treitz to terminal ileum.  In process of lysis of adhesions 2 enterotomies were created mid jejunum and mid small bowel. They were repaired.
The right colon was mobilized and the transverse colon was mobilized.  The splenic flexure was not mobilized.  The patient has end ostomy on left side of body and incision was made in skin and ostomy was dissected off abdominal wall then delivered back into the abdomen and mobilized.
the patient has a segement of left colon attached to the rectum from previous surgery, measuring about 1 foot long.  The mesentery to the transvers colon, splenic flexure and right colon was taken down close to the bowel in order to prevent damage to marginal artery.  The blood supply to the specimen in the right colon specimen was removed and opened and examined.
After this procedure was done, a sis to side terminal ileum to left colon asastomosis was performed, the mesentery defect was closed.  The abdomen was washed out, counts were correct, no bleeding, anastomosis was secure, the enterotomies were secure, the bowel was laid down, not twisted, the abdominal wall defect from the ostomy was closed. the abdominal fascia was closed, skin left open and packed.


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## mstallings (Dec 14, 2011)

I would look at 44140....I would not code the small bowel repair. The lysis will be 44005, however check your CCI edits, because the lysis is usually bundled with everything. The anastomosis is included in the colectomy. Hope this helps


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## mstallings (Dec 14, 2011)

Let me explain the repair, since this was done due to the adhesions, I would not code this out separate, since it appears from the note it was caused by the adhesions.


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## FKhan (Dec 14, 2011)

*Coder*

This looks like a takedown of a colostomy therefore, I would code it as 44626.


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## Lujanwj (Dec 15, 2011)

Definitely a take down of colostomy but there isn't a take down code that includes ileo-colo anastomosis.  I think 44160 would be more appropriate.  That will included the partial colectomy and the ileocolostomy.  

You could try this scenario:
44160 -22 for extensive lysing 
44603 -59   w/ 998.2  
44139


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## kumeena (Dec 15, 2011)

Can somebody explain what is the term "take down colostomy"

Thank you


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## Lujanwj (Dec 15, 2011)

OpNote states: "The patient has descending end ostomy in left side of abdomen".  Dr removed/took down the end ostomy, did partial colon resection and created a Ileocolostomy ("terminal ileum to left colon asastomosis was performed").


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## DLS5697 (Dec 19, 2011)

44626 - Dr. is taking down the colostomy, just means closing the colostomy site and hooking the colon back up, he refreshes the colon edges before putting them back together, the resection is included, cannot bill for it separately.


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## MSUEEMBRY (Dec 27, 2011)

Thanks to everyone for the help!


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