Gastroenterology Coding Alert

Ask the right questions, and you shall have the answers.

Do you want a headache-free search for a code to describe your enterostomy closure claim? You're one step ahead if you ask the question, "Did the surgeon also perform resection and anastomosis of the bowel?" You may be looking at some separately reportable services that can boost your reimbursement.

Test Yourself with These Scenarios

Scenario 1: The GI surgeon performs coloproctostomy with colostomy (44146, Colectomy, partial; with coloproctostomy [low pelvic anastomosis], with colostomy) for a patient with colon cancer. Four months later, the surgeon closes the colostomy without bowel resection. What code should you report?

Scenario 2: The GI surgeon performs a colostomy closure and resects a large segment of rectosigmoid before completing the anastomosis. He takes down the stoma and resects a small piece of bowel from it. He then goes down to the rectum/sigmoid, and resects a large piece of bowel, hooking the two ends together. There is only one anastomosis, and one diagnosis (V55.3, Colostomy status). What code should apply?

Scenario 3: The GI surgeon sees a patient with severe abdominal pain, a history of diverticulosis and rebound tenderness. She performs an exploratory laparotomy of the abdomen and identifies severe diverticulitis -- in this case, a large abscess in the sigmoid colon.

The surgeon decides not to resect the sigmoid and instead performs a transverse loop colostomy (44320, Colostomy or skin-level cecostomy;). In addition, the surgeon drains the peritoneal abscess (49020, drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; open).

After a few months, when the inflammation and infection have resolved, the surgeon performs sigmoid colectomy with primary anastomosis (44145, Colectomy, partial; with coloproctostomy [low pelvic anastomosis]). He also decides to close the original loop colostomy simultaneously. How should you report it?

You think you know how to tackle these coding situations? Turn to page 69 for the solutions, and compare your answers.