General Surgery Coding Alert

Mobilization of splenic flexure calls for add-on code Not all partial colectomy procedures are created equal, and close attention to the op report's details could uncover hidden reimbursement opportunities. Here are six tips on what you-ll want to be watching for. 1. Choose the Approach for a Basic Procedure To report a partial colectomy, you should choose either 44140 (Colectomy, partial; with anastomosis) for a simple approach or, for a combined abdominal/transanal approach, 44147 (... abdominal and transanal approach). If the surgeon refers to the transverse colon, chances are she performed a "straight anastomosis" as described by 44140. Regardless of the approach, the surgeon will remove the diseased section of colon and reattach the distal and proximal ends of the remaining colon. Know your terms: The surgeon won't typically dictate "partial colectomy" in the op note, says M. Trayser Dunaway, MD, a surgeon, speaker, coding educator and healthcare consultant in Camden, S.C. Instead, the surgeon will typically write "right hemicolectomy," "left hemicolectomy," "sigmoidectomy," or "subtotal colectomy." 2. Look for Coloproctostomy First When reviewing a colectomy op report, you should first determine whether the surgeon performed a coloproctostomy, or low pelvic resection and anastomosis. For coloproctostomy with partial colectomy, report 44145 (... with coloproctostomy [low pelvic anastomosis]). 3. Choose Your Colostomy Code Next, scan the op note for evidence of a colostomy, which the surgeon often performs to divert the fecal stream away from the site of the anastomosis or even the entire distal colon and thus facilitate healing. The surgeon may perform the colostomy using one of several methods, says Terri Brame, CPC, CPC-H, principal at BEST Coders. During the more typical "loop" colostomy (44141, ... with skin-level cecostomy or colostomy), the surgeon will open only part of the colon wall without complete resection of the colon. A Hartmann procedure, or "end" colostomy (44143, ... with end colostomy and closure of distal segment [Hartmann type procedure]), involves bringing the proximal end of the colon to the skin surface as a stoma. Along with an 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 ileostomy and creation of mucofistula). All-in-one special: If the surgeon performs both coloproctostomy and colostomy, along with partial colectomy, you should use 44146 (... with coloproct-ostomy [low pelvic anastomosis], with colostomy). 4. Watch for Ileum Removal During right hemicolectomy, the surgeon typically removes the terminal ileum when reconnecting the ileum to the distal remaining colon because the blood flow to the cecum isn't good enough to make a cecum-colonic anastomosis, Dunaway says. In these [...]