General Surgery Coding Alert

Question: How should we code the following: exploratory laparotomy with drainage of multiple intra-abdominal abscesses, sigmoid colectomy, sigmoid colostomy, distal Hartmann's pouch, incidental appendectomy, and creation of silastic silo for delayed closure of abdominal wall defect?

Mississippi Subscriber

Answer: Based on the information available, it is likely that the only code that could be reported for all of these procedures is 44143 (Colectomy, partial; with end colostomy and closure of distal segment [Hartmann type procedure]). The sigmoid colectomy is a type of partial colectomy covered by 44143. Also included in this procedure is the exploratory laparotomy (49000), the drainage of the intra-abdominal abscesses (49020), the sigmoid colostomy and the appendectomy.

The silastic silo is created as a means of closing (but not permanently repairing) the wound. Any wound closure or repair is also included in 44143 and should not be billed separately. Although +49568 (Implantation of mesh or other prosthesis for incisional or ventral hernia repair [list separately in addition to code for the incisional or ventral hernia repair]) in many ways describes the type of repair using silastic silos performed here, it may not be reported because use of this code is specifically limited to incisional/ventral hernia repair, which was not performed.