General Surgery Coding Alert

Question: A patient had undergone an earlier extended left hemicolectomy with end colostomy due to Crohn’s disease. Now, due torecurrent bleeding, our surgeon performed a takedown of the colostomy, completion colectomy, and turnbull end ileostomy. The remaining colon consists of only the right colon. What is the correct coding for this second procedure?

Mississippi Subscriber

Answer: A possible code is 44144 (Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula). Typically, “completion colectomy” would be a total colectomy, but that’s apparently not the case here if most of the left colon had previously been removed and the right colon is still remaining. More information is needed to provide a definitive code recommendation.

For instance: You don’t state if the procedure involves an open or laparoscopic approach, but 44144 is for an open procedure only. Also, it’s unclear from your description whether the “completion colectomy”was actually a partial colectomy, based on the fact that the patient had a previous “extended left hemicolectomy” and the right colon (presumably the cecum and ascending colon) was intact at the end of the procedure you describe.

Questions remain: It’s unclear why an ileostomy was created when the ascending colon was still in place (ileostomy is typically only done with total colectomy) and what was done with the ascending colon if material was being diverted from the digestive tract after the ileum. It’s possible this is a temporary measure with an intention of creating some type of continent anastomosis between the remaining colon and the rectum at a future surgery.

Once you determine the proper code based on open or laparoscopic approach and partial or total colectomy, you might also be able to bill 44620 (Closure of enterostomy, large or small intestine) for closure of the old colostomy. However, that service would often be bundled in an open approach, so you may not be able to separately report the closure.