# Staged Bowel Surgery



## adri3421 (Apr 26, 2012)

I was just wonder how other people are coding staged bowel surgery.....

For example a trauma pt goe to the OR and the physician performs an ex-lap, and does damage control resection of the colon, & places a vac pac. The next day they go back and complete the anastomosis and close the pt up......

would it be 44140 for the first day and 49002 for the second day?


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## cwpierce (Apr 26, 2012)

Going by the info you have mentioned I would go with 44140-52 on day one and then go with 44130-58 on day two for the anastamosis. 49002 would become global to the surgical package of 44130-58.


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## adri3421 (Apr 27, 2012)

But 44130 is for anastomosis of the small bowel.......and it was the colon that was repaired.......any suggestions? Do you still think 44130 would be ok to report?


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## Lujanwj (Apr 27, 2012)

Common misconception.  Enteric refers to small intestine but entero refers to intestines in general.  

Taber's Med. Dic. Defines 

Enteroenterostomy: Surgical creation of a communication between two intestinal segments.

P.S. Does anybody have any documentation on correct reporting of staged procedure like this.  I was always taught that you would code this as 44140-52, 44140-52-58.


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## adri3421 (Apr 27, 2012)

*staged bowel procedures*

Any documentation on coding staged bowel procedures would be very helpful......I work for doctors who do it all the time & I really want to make sure we are coding it correctly.


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## adri3421 (Apr 30, 2012)

*staged bowel surgeries*

So I just talked with a coding specialist from American College of Surgeons and the way they recommend billing this would be: 44140-52 for the first day & 44140-5258 for the second day.


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## cmartin (Apr 30, 2012)

I go w/ 44140 on day one and 49002-58 on day 2.  It only gets complicated when they end up not doing what they expect to do at the 2nd, or other subsequent, sessions, so I wait to code the first until I know for sure what happens at the later sessions. But he's not doing 2 partial colectomies w/anasts, however modified, he's doing one, staged, w/ a 2nd look. 44140 & 49002-58.


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## Lujanwj (May 1, 2012)

I'm still looking/searching/begging for documentation for how to code this.  

I'm not a fan of coding 44140, 49002-58 for a couple of reasons.  No anastomosis or closure on 44140.  And 49002 Dr is not reopening the cavity since it was never closed.  I like the logic of using the same code for both services with -52 (don't reduce fees, let them do it) because at the end of the day Dr did a Partial Colectomy(stage 1); with anastomosis(stage 2).  That said, 44140-52 44130-58 would be the next best option.  Either way, do what works best for you because I don't know for certain.

Please post AMA or CMS Guidelines if you happen to find some.


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## cmartin (May 3, 2012)

Taking the wound vac off & taking the bowels back out is reopening enough for me. I still feel like whenever possible, if you have one resection and one anast, bill one resection and one anast. Like L. said, though, in the absence of any clear rulings in the matter, go with what works best, and seems most appropriate, to you.


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## adri3421 (May 4, 2012)

thanks for your replies!!!


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