# Please help, we are stumped!



## dawnlamb (Jan 26, 2011)

This surgery has seriously turned this day upside down, any help is appreciated on which CPT code(s) to use.  I have exhausted all of my resources here and we have no resolution; none of us can agree on what codes to use.  PLEASE HELP!

Procedures as described by physician:
Exploratory laparotomy with release of small bowel obstruction
Excision of right fallopian tube
Decompression of small bowel obstruction

Scrubbed note:

A midline incision was made through a previous surgical scar, and dissection was carried down to the anterior fascia. The fascia was opened and the peritoneum was entered.  The abodominal cavity was opened.  The small bowel was very distended upon opening the abdominal cavity.  The small bowel was delivered out of the abdominal cavity.  There was an area of obstruction present in the RLQ.  A remnant of a fallopian tube was seen to arise from the RLQ and then extend across the small bowel in an obstructing fashion.  The fallopian tube was then divided between clamps, and hemostatis was obtained with 2-0 Vicryl ties.  This released a segment of the small bowel.

An additional segment of the small bowel was further compromised with the residual fallopian tube.  This segmentwas also divided between clamps.  Hemostasis was obtained with 2-0 Vicryl ties.  This further freed up the small bowel obstruction.  

The small bowel was then followed down to the ileocecal area.  Additional adhesions were present in this area and had to be dividd between clamps.  Hemostasis was obtained with 3-0 Vicryl ties.  This seemed to further free up the small bowel, almost up to the ileocecal valve.  At the area of the ileocecal valve, additional adhesions were present, and these were divided between clamps and ligated with 2-0 Vicryl ties.  This freed up the ileocecal region.

The small bowel was then completely removed from the abdominal cavity.  I explored the small bowel from a proximal to distal direction, and no additional areas of obstruction were identified.  The residual fallopian tube was submitted for permanent pathology.  The bowel was very distended.  The small bowel was then decompressed in a distal to proximal direction manually.  This was done with an NG tube in the stomach.  Approximately 1400 mL of fluid was evacuated from the small bowel using this technique.  

I have a bad feeling that the only thing we can code is 49000-22, but if you have any other thoughts, please share!

I have spent so much time on this case, that now, I am completely at a dead end.  Anything you can send my way is greatly appreciated!!!!!


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## eware (Jan 26, 2011)

Dawnlamb,

Have you looked at 44050?  After reading your op note description, I looked in the index under Intestines, Small and located repair, obstruction.  It references code 44050.  I also checked encoderpro's description of this procedure, and it is really close to the procedure that your physician performed.  It seems as though the residual FTube created a volvulus.  This code also includes the laparotomy portion of the procedure.


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## acombspsa (Jan 27, 2011)

I wouldn't recommend 44050. That is for a manual reduction of volvulus or intussusception. Your surgeon says he resected part of the fallopian tube, small bowel, and adhesions. I would look at 44005, 44120 + 44121 (but not sure about anastamosis, that is not mentioned) or 58700.


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## dawnlamb (Jan 28, 2011)

Thank you so much for the input!  It is so nice to know that there are people out there willing to help us!!  We are still doing some more research to try to find the best codes, so anyone else who has thoughts regarding this surgery, please share


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## bran1120 (Jan 28, 2011)

Per the op note, there is no actual bowel resection, only excision of the fallopian tube and adhesiolysis (usually bundled into the other procedure).  The only specimen referrenced for pathology is the fallopian tube which again would indicate there is no bowel resection happening therefore you would not be able to code a 44120.  Your best option appears to be cpt 58700.  

You may be able to append modifier 22 due to the adhesions as well as the inspection of the small bowel which is above and beyond what would normally be considered part of a routine salpingectomy.


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## preserene (Jan 28, 2011)

The procedures undertaken are:
 Laparotomy, reduction of bowel obstruction, segmental extensive segmental release of the small bowel at different areas of the bowels, and Fallopian tube stump excision.

The codes I would like to suggest would be:
44050, 58700, 44005-59.
There was neither resection of the bowel nor anastomosis of the ends taken place at all.
Hope this satisfies the whole scenario.
thank you


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## cynthiabrown (Apr 21, 2014)

44005 is a seperate procedure and not billable


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