# small bowel endoscopy w/ enterectomy & ileostomy



## BABS37 (Aug 2, 2012)

Can I code this? Physician did a small bowel endoscopy via ileostomy- he scoped her and then terminated the procedure as there was a massive tumor. He took the patient to the recovery area to consult with her family and they decided to do surgery. I was going to code it 44385-53.

 His next surgery was this :the wall of the small bowel was identified and separated from the mucous fistula and dissected down to the fascial level. A firm nodule invading the wall of the samll bowel at the transition point was identified. This was resected and blocked with the distal small bowel and more proximal small bowel was delivered up to the skin edges and matured into a new ileostomy. Large amounts of stool then exited from the ileostomy indicating relief of obstruction. An ostomy appliance was placed...

So which one do I code for? And how is the second surgery coded? I haven't found one that fits. Any thoughts?


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## johnstond (Aug 5, 2012)

*Debbie J*

Take a look at 44380 for the endoscopy procedure (vis stoma)and 44125 for the small bowel resection with creation of new enterostomy. CPT 44125 would be listed first (higher RVU value) and 44380 listed second. Also check CCI edits for possible bundling


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## BABS37 (Aug 6, 2012)

Thank you Debbie!


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