Gastroenterology Coding Alert

Question: The GI surgeon performs coloproctostomy with colostomy for a patient with colon cancer. Four months later, the surgeon closes the colostomy without bowel resection. What code should you report?

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Answer: The CPT^® code for coloproctostomy with colostomy is 44146 (Colectomy, partial; with coloproctostomy[low pelvic anastomosis], with colostomy). However, the patient underwent that procedure four months back, so you need tofocus on coding for the colostomy without bowel resectionnow.

For a basic takedown of enterostomy without bowel resection, you would report 44620 (Closure of enterostomy, large or small intestine). Look for clues in the documentation, such as a description of taking down the stoma of the colon and sewing it back together. The provider may elect to perform the closure weeks or even months after the initial colostomy procedure. It’s important to check the operative report, and see what the surgeon actually did.