# Looking for help!



## MSUEEMBRY (Mar 19, 2015)

I need any help that I can get coding this procedure, it has me stumped.

NAME OF PROCEDURES
1. colonoscopy via stoma and rectum
2. manual reduction of incarcerated colostomy prolapse
3. Exploratopy lap with lysis of adhesions
4. Right colopexy
5.  Anterior resection with primary EEA anastomosis

61 yr old male with hx of closed loop large bowel obstruction from rectosigmoid carcinoma at 18 cm with diverting ascending colostomy  4 months ago.  He reports to office with prolapse nonreducible ostomy.

Patient taken to OR, Colonoscopy performed via stoma could only pass to rectosigmoid region. The scope then was inserted thru rectum and advanced 18 cm to the obstructing tumor.  The ostomy prolapse was reduce with the patient under general anesthesia.  Abdomen prepped/draped, serial towel placed over ostomy to exclude during procedure.  Midline incision made in abdomen down to the anterior fascia. Lysis of adhesions was performed.  Adhesions were lysed from pelvic sidewall around the ostomy, the ascending colon was tacked to right pelvic sidewall. No lesions identified, gallbladder normal. small
 bowel normal in appearance.  In low rectum sigmoid colon was mobilized medially, the margin which is proximal to the tumor was divided with GIA 75 stapler. The dissection carried down to colonic mesentery down to sacral promontory. Mesentery taken down between Kelly clamps divided and ligated. Prerectal fascia identified and blunt idssection carried down the hollow of sacrum. The mesorectal tissue excised alone the sidewalls. Dissestion then carried beyond the tumor and spot chosen was about 4cm distal to the tumor.Contour stapler placed across this area and divided. The vascular pedicles had all been liberated and specimen sent for path. operative field was irrigated. The recum was sized with sizers up to 33 mm. A 33 mm EEA stapler was opened.  The anvil removed and pursestring suture placed.  The colon was opened in this region, the anvil inserted and pursestring suture ligated.  EEa stapler inserted into rectum and staple closed, fired, released and removed.  Air testing showed no leak. Midline incision was closed, Ostomy applicance place. sterile dressing placed, ostomy clamps placed. procedure terminated.

I don't think the manual reduction of colostomy will be billable, Wondering if I could use 44388, 45330, 44602, 44145 as CPT codes???

Any help will be appreciated.


----------



## cynthiabrown (Mar 19, 2015)

scout endoscopies are not payable......I don't see suture of small intestine anywhere. Which leaves 44145.Any one else?


----------



## CELADYBUG13 (Mar 20, 2015)

Agree, 44145.  The simple revision of colostomy is bundled and as Cynthia stated the scopes were scouting and not billable.


----------



## MSUEEMBRY (Mar 24, 2015)

Thank you for your help.


----------



## cynthiabrown (Mar 24, 2015)

You're welcome


----------

