# small bowel resection



## renee.lyle (Oct 7, 2009)

This is the patients 3rd sx over 1 month period. Midline incision was reopened in its entirety. Patient was found to have significant amount of succus material from sm bowel. There was a small dehiscence of the anastomosis, but pt has such friable sm bowel, an anastomosis could not be done safely in that area. I decided at that time to bring an end ileostomy in that area, approx 200cm frm ligament of Treitz. this was brought out in the uppr lft quad. Upon completion of evaluating of sm bowel, pt had an enterotomy approx 15 cm from the sm bowel to colon anastomosis in th rt colon from prev sx 20 yrs ago. Could not repair due to quality of sm bowel, I decided to bring out that enterotomy and create a mucus fistual in rt lower quad. Ileostomies were matured. 

I am really struggling with these types of sx. If you could please help in any way, I would greatly appreciate it. I know I will need to use mod 78 but as for cpt code, I really just don't know.


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## jaimewicklund (Oct 7, 2009)

I would take a look at 44310.  The open lap is going to bundle into the main procedure, and since the enterroraphy could not be done, I would lean more towards billing for the two ileostomies (using a -59 on one) Just my opinion


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## renee.lyle (Oct 8, 2009)

so would I code 44120-78 and 44310-59-78


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## jaimewicklund (Oct 8, 2009)

based on what was posted-I don't see that a small bowel resection was done. If you want to post the whole operative report (scrubbed) I would be happy to give you my opinion.


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