General Surgery Coding Alert

Question: A presumptive diagnosis of acute appendicitis was made on a patient in the emergency department. The patient was taken to the operating room, where it was discovered that he did not have appendicitis, but rather an inflammatory mass in the lateral portion of the cecum. As a result, a segmental resection of the cecum and distal 2 inches of the ileum was performed that also included the area of the appendix. The distal ileum and ascending colon were then brought side by side and a side-to-side anastomosis was done. The pathology showed ruptured diverticulum, and the appendix was unremarkable. Could this be a partial colectomy?

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Answer: The correct code for the described procedure is 44160 (colectomy with removal of terminal ileum and ileocolostomy), says Elaine Elliott, CPC, an independent general surgery coding and reimbursement specialist in Stuart, Fla. The ileocolostomy can be confusing because it is often mistaken for a skin-level colostomy. In fact, ileocolostomy describes an anastomosis of the ileum to the colon and is unrelated to a skin-level colostomy.

The original appendicitis diagnosis may also be confusing. Although the surgeon originally planned to remove the appendix and subsequently did remove it as part of the resection of the cecum and ileum, the appendectomy code is nonetheless incorrect. In this case the appendix is connected to the portion of bowel that was inflamed and removed and, therefore, the appendectomy is totally incidental to the partial colectomy.