# Colostomy takedown, Splenic flexure takedown, hernia repair, and xenograft



## mieka.schambach (Mar 30, 2015)

Please help code the following, we coded as so, but 2 of the codes are add on codes and keep denying as not billed with primary code. However, physician did not perform either primary procedure:

Procedures: Robotic colostomy takedown with colorectal anastomosis.; Robotic incisional hernia repair.; Robotic splenic flexure takedown.; Placement of a biologic xenograft.  

Problems 
DIVERTICULITIS OF COLON (WITHOUT HEMORRHAGE) (562.11), Acute sigmoid diverticulitis - with macro-perforation - s/p Hartmann's procedure, now with colostomy. (assessed) 
COLOSTOMY STATUS (V44.3),  
OTHER VENTRAL HERNIA WITHOUT OBSTRUCTION OR GANGRENE (553.29), Peristomal and incisional ventral hernias. (assessed)  

Orders The following tests/treatments were performed: 
LAPAROSCOPY, SURGICAL, CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE, WITH RESECTION AND ANASTOMOSIS (44227), Note: Robotic colostomy takedown with colorectal anastomosis. , DIVERTICULITIS OF COLON (WITHOUT HEMORRHAGE) (562.11), COLOSTOMY STATUS (V44.3)

LAPAROSCOPY, SURGICAL, MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH PARTIAL COLECTOMY (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) (44213), Note: Robotic splenic flexure takedown.,Indication(s): DIVERTICULITIS OF COLON (WITHOUT HEMORRHAGE) (562.11), COLOSTOMY STATUS (V44.3)

LAPAROSCOPY, SURGICAL, REPAIR, INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED (49655-51), Note: Robotic Incisional Hernia Repair Indication(s): OTHER VENTRAL HERNIA WITHOUT OBSTRUCTION OR GANGRENE (553.29)

IMPLANTATION OF BIOLOGIC IMPLANT (EG, ACELLULAR DERMAL MATRIX) FOR SOFT TISSUE REINFORCEMENT (IE, BREAST, TRUNK) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) (15777), Note: Placement of a biologic xenograft., Indication(s): DIVERTICULITIS OF COLON (WITHOUT HEMORRHAGE) (562.11), COLOSTOMY STATUS (V44.3), OTHER VENTRAL HERNIA WITHOUT OBSTRUCTION OR GANGRENE (553.29)


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## Highlyfavored (Mar 30, 2015)

In order to help with the coding we would need to see the entire operative report.  But from what I am looking at, 44213 laparoscopy mobilization take-down is ONLY payable with 44204-44208.  I don't see that any of those codes in that range were billed.

Also 15777 is an implantation of biologic implant(ie, breast,trunk).  I don't know the reason that procedure but the diagnosis that were billed is not consistant with the procedure.  

Please provide more information


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