General Surgery Coding Alert

Question: A patient previously has undergone a right hemicolectomy. Now the patient has a recurrence of the tumor involving both the small intestine and the transverse colon where the previous anastomosis was performed. The surgeon removes a portion of the transverse colon and a portion of the small bowel. Anastomosis is performed between the remaining transverse colon and remaining small bowel. How do I properly code the anastomosis between the small bowel and transverse colon?

Anita Adair
Schenectady, N.Y.

Answer: The correct code for this procedure is 44160 (colectomy with removal of terminal ileum and ileocolostomy), says Kathleen Mueller, RN, CPC, CCS-P, an independent coding and reimbursement specialist in Lenzburg, Ill., because portions of both colon and small intestine have been removed and the two intestines are anastomosed. Mueller notes that coders often fall into a trap when billing for such colectomies, especially if they are described as right colectomies.

Although right colectomy is an accurate description, many coders confuse right and partial colectomies because a right colectomy is indeed a type of partial colectomy. It is a specific kind of partial colectomy, however, that has its own code. The general partial colectomy code, 44140 (colectomy, partial; with anastomosis) should be used when portions of the colon are removed and the remaining sections are anastomosed. In this case, because the colon and small intestine are reconnected, 44160 more specifically describes the procedure.