General Surgery Coding Alert

Question: Our surgeon performed a laparoscopic low-anterior colon resection with a diverting ileostomy. Is 44208 the correct code for the procedure, even though the surgeon did not perform a colostomy?

Virginia Subscriber

Answer: No, you should not code the procedure you describe using 44208 (Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy [low pelvic anastomosis] with colostomy).

You've identified the problem with using that code -- the surgeon did not form a colostomy, but instead, did a diverting ileostomy.

Do this: Code the procedure as 44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy [low pelvic anastomosis]) plus 44187 (Laparoscopy, surgical; ileostomy or jejunostomy, non-tube).

Correct Coding Initiative (CCI) edits don't bundle these two codes, which means you don't need modifier 59 (Distinct procedural service) to bill the codes together. Most payers no longer require you to list modifier 51 (Multiple procedures), but you can expect a multiple-procedure discount to be applied to 44187. Make sure you report 44187 as the second code on the claim, because it has the lower RVUs (32.39 versus 53.53 for 44207) and, therefore, is the code that should receive the payment reduction.

Here's why: Payers apply the multiple procedure discount, paying the second procedure at 50 percent, because each surgical CPT® code includes preop, postop, opening, closing, and other services that aren't duplicated when the surgeon performs two procedures at the same operative session.

Opportunity: If the surgeon also documents the take-down of the splenic flexure, you can also list +44213 (Laparoscopy, surgical, mobilization [take-down] of splenic flexure performed in conjunction with partial colectomy [List separately in addition to primary procedure]).