General Surgery Coding Alert

Don't overlook associated procedures, or you'll be giving up reimbursement When reporting colectomy, chances are you can upcode from a basic partial colectomy and increase the reimbursement your surgery practice collects if the report contains any of the following six terms: cecostomy, colostomy, ileostomy, or ileocolostomy, coloproctostomy and splenic flexure.
 
Here are five expert-approved tips to make the most of your colectomy claims: 1. Begin With 44140 To report an open, partial colectomy only, you should choose 44140 (Colectomy, partial; with anastomosis), says M. Trayser Dunaway, MD, a general surgeon in Camden, S.C. During this procedure, the surgeon removes the diseased section of colon and reattaches the distal and proximal ends of the remaining colon.
 
Unique approach means unique coding: If the surgeon chooses to perform a partial colectomy and anastomosis by abdominal and transanal approach, you should select CPT 44147 (... abdominal and transanal approach) rather than 44140.
 
Look for coloproctostomy first: When reviewing a colectomy operative report, the first "additional" procedure you should look for is a coloproctostomy, or low pelvic resection and anastomosis. For coloproctostomy with colectomy, report 44145 (... with coloproctostomy [low pelvic anastomosis]). 2. Add Choices With Colostomy Next, you should search the documentation for evidence of a colostomy. During this procedure, the surgeon diverts the fecal stream away from the site of the anastomosis to facilitate healing.
 
For a colostomy only with partial colectomy and anastomosis, choose 44141 (... with skin-level cecostomy or colostomy).
 
In some cases, the surgeon may perform an "end colostomy," or Hartmann procedure, during which he brings the proximal end of the colon to the skin surface as a stoma, says Gary W. Barone, MD, associate professor of surgery at the University of Arkansas for Medical Sciences in Little Rock. This differs from the more typical "loop" colostomy described by 44141: Loop colostomy implies that only part of the wall of the colon is opened (usually the antimesenteric wall), and the colon is not completely transected, Barone continues. Therefore, you should report an end colostomy using 44143 (... with end colostomy and closure of distal segment [Hartmann type procedure]) rather than 44141.
 
If the surgeon performs both colostomy and coloproctostomy, you should call on 44146 (... with coloproctostomy [low pelvic anastomosis], with colostomy). 3. For Mucofistula With Colostomy, Jump to 44144 Don't stop reading the operative report when you decide on the type of colostomy the surgeon performed: There's another option, possibly further on in the documentation, to consider.
 
Along with end colostomy, the surgeon may create a mucofistula, or a "mucus fistula," which brings the proximal end of the now nonfunctional colon remainder to the skin level, Dunaway says. To report such a procedure, choose 44144 (... with resection, with colostomy or [...]