# Colonoscopy the day before colostomy reversal



## ch81059 (Aug 14, 2013)

Hi everyone,

I have an operative report that I'm trying to code and I need a little help.  The patient had a prior Hartmann procedure secondary to perforated diverticulitis.  Patient was scheduled for a colonoscopy the day before he was due to have the colostomy reversal.  The patient has Medicare.  I have attached the operative report and need some assistance figuring out what CPT codes and ICD-9 codes to use since this is a Medicare patient.  I don't know if I have to use the G0201 or if I can use something else.  The patient had the colonoscopy through the anus and through the stoma as well as fecal impaction removal.

PREPROCEDURE DIAGNOSES:

1. Past surgical history of end colostomy placement with Hartmann procedure.
2. History of perforated diverticulitis.
POSTPROCEDURE DIAGNOSES:

1. Past surgical history of end colostomy placement with Hartmann procedure.
2. History of perforated diverticulitis.
PROCEDURES:

1. Colonoscopy.
2. Manual disimpaction of stool from rectal vault.

ENDOSCOPIC FINDINGS: Normal colonoscopy via anus and via left lower quadrant end colostomy.
INDICATIONS: Mr. xxxxxxxx is an 83-year-old gentleman, who in the past underwent an exploratory laparotomy with Hartmann procedure and end colostomy placement secondary to perforated diverticulitis. The patient now desires reversal of his ostomy. The patient was set up to have a colonoscopy with ostomy reversal the next day. Risks, benefits, and alternatives of colonoscopy were explained to the patient in great details. All questions were answered. The patient agreed to proceed with surgical procedure. Consents were signed freely. The patient was instructed to use an oral bowel prep as well as multiple enemas via his anus.

DESCRIPTION OF PROCEDURE: The patient was taken to the endoscopy suite and placed in the left lateral decubitus position. After adequate IV sedation by Anesthesia, the digital rectal exam was performed. No masses or lesions were seen. No evidence of internal or external hemorrhoidal disease.  The anus appeared normal in its anatomy and function. The scope was then passed through the anus in the proximal rectal vault. Multiple stool balls were noted. These were unable to be washed out and were unable to be advanced or pass with the scope. The scope was withdrawn. I manually disimpacted these multiple rectal vault stool balls and then re-performed the colonoscopy via the anus. His rectum and distal sigmoidal stump showed no evidence of masses or lesions. The scope was retroflexed. No
evidence of internal hemorrhoidal disease. l11e scope was withdrawn. Attention was then drawn to the left lower ostomy. The scope was passed to the ostomy to the cecum. Reported findings are as follows: Bowel was excellent. Cecum, no masses or lesions. Ascending colon, no masses or lesions. Hepatic flexure, no masses or lesions. Transverse colon, no masses or lesions. Splenic flexure, no masses or lesions. Descending colon, no masses or lesions. Ostomy appeared pink and viable. This completed procedure. The bowel was decompressed and the scope was withdrawn. The ostomy bag was replaced.  The patient is to have a colostomy reversal tomorrow. The patient was then transported awake, alert and in good condition back to the recovery room.

Any assistance would be greatly appreciated.  Thanks!


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