Gastroenterology Coding Alert

Question: Our surgeon treated a patient with Crohn’s disease who had both a colon perforation and a small intestine stricture. The GI physician performed abdominal laparoscopy and removed the affected colon section, joining the two excised ends with anastomosis. The surgeon advanced the laparoscope to the region of the small intestinal obstruction, and excised a small section, also performing anastomosis at this site. Which codes apply to this case?

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Answer: If you decided to report just one procedure code for this case, you’d stand to lose a lot of pay. In many circum­stances, you can separately report multiple surgical laparoscopic procedures that your surgeon performs during a single operative session. The appropriate codes for this service are listed below:

Procedure:

• 44204 (Laparoscopy, surgical; colectomy, partial, with anastomosis)
• 44202 (Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis)

Diagnosis:

• K50.812 (Crohn’s disease of both small and large intestine with intestinal obstruction)
• K50.818 (… with other complication)

Some coders believe that the op report must document separate incisions before you can code multiple scopes, but that’s simply not true. If you check Correct Coding Initiative (CCI) edits, you’ll see that there’s no restriction against reporting together 44204 and 44202.

Caution:  You will find a few surgical scopes subject to edits, however, such as 44970 (Laparoscopy, surgical, appendectomy), which CCI bundles with many other surgical lap procedures. That means you should always check the CCI edits.

If you added 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) to your billable codes for this Crohn’s case, you would be wrong. You should never report a diagnostic scope in addition to a surgical scope for the same surgery, because the surgical procedure pay includes the diagnostic scope.

Home in on Dx Codes: If you reported a diagnosis code such as K56.60 (Unspecified intestinal obstruction) or K63.1 (Perforation of intestine (nontraumatic)), to describe the intestinal obstruction and perforation in this case, you would be wrong. In fact, an Excludes 1 note under K56.60 prohibits this code for “intestinal obstruction due to specified condition,” and instructs you to “code to condition.”

Because the patient has a Crohn’s diagnosis, you must code Crohn’s with the appropriate complication(s). The correct codes are K50.812 for the intestinal obstruction complication, and K50.818 for the bowel perforation complication.

Deconstruct code: K50.8- indicates that the patient has Crohn’s disease of both the small and large intestine. The fifth character signifies no complication (0) or presence of complication (1). The sixth character identifies the type of complication, such as obstruction (2) or fistula (3).