# subtotal colectomy with end ileostomy



## dovejsd (Feb 23, 2011)

Physician did a subtotal colectomy with end ileostomy.  I found CPT 44144 for colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula, which is perfect except for the mucofistula part.  Suggestions? Thanks.


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## surgonc87 (Feb 23, 2011)

Please post op note


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## dovejsd (Feb 25, 2011)

*op note added*

Here is the op note.  Any help you can give me will be greatly appreciated!!!

A midline incision was made, extending above and below the umbilicus. Upon entering the peritoneal cavity, there were no bowel contents, no pus. There was some serosanguineous fluid. However, it was noted that the colon was diffusely dilated moderately, dilated to severe dilatation on the right side and cecum area, though there was no fresh perforation, also with thickened wall and edematous mesentery, consistent with diffuse colitis. So we went ahead and at this point decided to go ahead and do a subtotal colectomy, all the way down to the level of the upper rectum. The left and right peritoneal line were taken and divided. The splenic flexure and hepatic flexure also were carefully taken down. The gastrocolic ligament and omentum were also divided. Using the ligature proximally, the intestine was divided at the level of the distal small intestine, about 7 cm from the ileocecal valve with a GIA stapler and then distally also at the rectosigmoid junction and then the mesentery of the bowel was sequentially ligated at times with 2-0 and 0 silk and with the ligature stitches.  JP drain was left in this area and secured to the skin with 3-0 nylon stitch and brought out in the right lower quadrant of the abdomen, a separate stab wound.  The distal ileum was then fashioned and brought out as an end-ileostomy in the right lower quadrant of the abdomen, halfway between the iliac crest and the umbilicus, where a cruciate incision was made to admit easily two fingers in the fascia between the muscles.  We made sure to bring out the end stapled ileum through this opening without any twist or irritation in its mesentery and then from inside it was tagged and secured with some seromuscular 3-0 Vicryl stitches between the wall of the loop of this ileum to the dermis of the skin and at some points also by bringing it out as almost as a Brooke ileosotomy, by taking some seromuscular stitches to the bite. Dressings were placed appropriately.


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## surgonc87 (Feb 25, 2011)

Sounds like a total colectomy to me! If you have a coders's desk reference or Encoderpro, check out the discription of CPT, key words in there, divided at colorecto junction, your op says divided at the Rectosigmoid junction...same thing

44150

That is exactly how I would code it, have a good day


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## dovejsd (Feb 28, 2011)

Thanks for your help!


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