Gastroenterology Coding Alert

Question: Our GI surgeon recently performed a complete proctectomy on a patient with congenital megacolon who could no longer defecate on his own. How should I report the procedure, and what ICD-9 code(s) should I include?

Mississippi Subscriber

Answer: When reporting complete proctectomies, you have two choices:

1. Code 45120 (Proctectomy, complete [for congenital megacolon], abdominal and perineal approach; with pull-through procedure and anastomosis [e.g., Swenson, Duhamel, or Soave type operation) if the gastroen-terologist didn't perform a colectomy or biopsy in addition to the proctectomy.
2. Code 45121 ( ... with subtotal or total colectomy, with multiple biopsies) if the physician performed a colectomy and/or biopsies were taken.

No matter which proctectomy code you use, include the ICD-9 code 751.3 (Hirschsprung's disease and other congenital functional disorders of the colon). This diagnosis code is also acceptable for aganglionosis, congenital dilation of the colon and macrocolon.