Gastroenterology Coding Alert

Question: One of our physicians performed coloproctostomy with colostomy for a patient with colon cancer. Four months later, the surgeon closed the colostomy without performing a bowel resection. Which code applies to this situation?

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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 ago, so you need to focus on coding for the colostomy without bowel resection now.

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 before submitting the code for your claim.