# Lower anterior resection with ileostomy



## MEZIESKY (Jun 27, 2013)

Help Please,
When our Dr does a open lower anterior resection with diverting loop ileostomy do we use the 44145 and 44310 or the 44146. The 44146 is with colostomy would that also be for a ileostomy?
Thank you,
Marie


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## Williealawishes (Jul 3, 2013)

I would think it depends on what they did with the resected area.  If they closed one end and created an ostomy with the other end I would use 44143.  If they reattached the ends and created an ostomy above this area I would use 44146.  Would love to hear what others think!


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## cynthiabrown (Jul 5, 2013)

I think 44145 and 44310


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## cmartin (Jul 10, 2013)

44145 and 44310. Check the CCI to see if you need to put a -59 anywhere. It may SEEM obvious that they were in different locations, but that has nothing to do with whether they are paired in the CCI! If the code says colostomy, I don't use it for an ileostomy - the patient will need supplies, they may need revision, since this is diverting, they'll have a closure - so those future dxs/procedures will not match up with your claim if you've used one that includes a colostomy. Plus, it just isn't what was done. Wish there was a modifier for things like this that meant "just slightly different - not more or less" LOL!


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## Williealawishes (Jul 11, 2013)

That makes perfect sense!!!  Looking at it now I am not sure why I viewed it as "ostomy" in general.  Love these threads!!!  Very helpful!  Thanks for the info Ladies!


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## MEZIESKY (Jul 12, 2013)

Thank you everyone. Yes I love these threads


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## Kisalyn (Jul 17, 2013)

Hoping to get some clarification regarding a similar case in a coding publication we get for general surgery. It states the best code for this case is 44145. 

"The surgical note documents an ileostomy, but you can't bill it separately. An ileostomy is usually temporary for these types of cases, and is included in the colectomy code, when performed."

If you need the example case, I can post it. They answer this reader question with you shouldn't report 44310 with 44145, but a few months earlier answered a reader question where the correct CPTs are 44145 + 44310.

My question is are there certain instances of 44145 that you won't report an ileostomy (44310) when the physician performs one?

Thanks for any direction!


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