# Hemicolectomy with Brooke ileostomy



## R1CPC (Mar 30, 2015)

doctor removed cecum, ascending colon, up to transverse colon, part of terminal ileum was resected to create a brooke ileostomy. What CPT do we use??? Help please


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## afalcon@dhcla.com (Mar 30, 2015)

More information is needed in order for me to try to help. Was it partial, open, total, laparoscopic ????? maybe look at 44144  or 44150-44151


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## R1CPC (Mar 30, 2015)

sorry about that it was partial, open..


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## afalcon@dhcla.com (Mar 31, 2015)

44144 would be my guess. I haven't coded one of these in a long time.


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## R1CPC (Mar 31, 2015)

But he didnt create a mucofistula only the ileostomy


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## cynthiabrown (Mar 31, 2015)

44141


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## R1CPC (Apr 1, 2015)

but he brought out the ileum as an ileostomy how would this apply to cpt 44141?


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## cynthiabrown (Apr 1, 2015)

moving for ward, you should probably post the note for us


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## cynthiabrown (Apr 1, 2015)

What happen with open end of transverse colon


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## cynthiabrown (Apr 1, 2015)

A brooke ileostomy is a double barrel ileostomy (mucous fistula) so you r code will be 44144


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## R1CPC (Apr 1, 2015)

thanks for your responce but I'm looking at the definition of a brooke type ileostomy and I don't see how this is a double barrel

The Brooke ileostomy is the second most common
type of ileostomy surgery. The terminal ileum is pulled
through the abdominal wall and a segment is turned
back and sutured to the skin, leaving a smooth, rounded,
everted ileum as the end of the ileostomy.
The stoma is usually placed in the right lower
quadrant whenever possible and located on a flat surface
sufficiently free from irregularities. The fecal output is not
controlled and will require wearing a collection pouch.

What part defines the double barel?

                                                                                                          A vertical midline incision
was made with scalpel and dissection was carried down through subcutaneous
tissue down to linea alba, which was opened vertically.  I explored the entire
abdomen with the above findings.  I then mobilized the lateral attachments of the ascending colon using Bovie electrocautery.  I then mobilized the hepatic flexure.  I got to the area of very healthy, viable mid to transverse colon and transected the colon with the GIA stapler at this point.  I then could see that the terminal ileum was quite clean and viable; I transected the bowel at this point with another GIA.  Subsequent ascending colon mesentery was taken downwith a LigaSure device, inclusive of the appendix.  I might add also that I could see the right tube and ovary and uterus and they were all atrophic. I then removed the ascending colon and sent it to pathology.I decided to give the patient an ileostomy.  I brought out the ileum in the right mid abdomen excising a core of skin and subcutaneous fatty tissue.  A cruciate incision was made in the anterior rectus sheath.  I then brought out end terminal ileum as an end ileostomy.I then irrigated the abdomen with a liter of normal saline.  I made sure I hadgood meticulous hemostasis.  I draped the omentum over the small bowel and closed the midline abdominal wound with a running looped 0 PDS suture.  I then closed the skin loosely with staples.  I then matured the ileostomy with a 3-0 chromic suture.  This was a Brooke ileostomy.  Coloplast bag was applied.


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## CELADYBUG13 (Apr 2, 2015)

If the path shows he removed the terminal ileum go with 44160 and 44310 (with appropriate modifier) for the ileostomy, but if the path show only the ascending colon I would look at 44140 and 44310. Usually the Brooke ileostomy is a temporary ileostomy.


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## cynthiabrown (Apr 3, 2015)

I swear I googled it and it said it was double barrell.my apologies


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