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General Surgery Coding Alert

Reader Question:

Takedown of Splenic Flexure

Published on Fri Feb 01, 2002

Question: CPT states that 44139 can be billed with 44140 to 44147. Are these the only procedures to which 44139 may be added? One of my physicians wants me to bill 44139 with 44150. Would that be correct?
           
Kentucky Subscriber
 
Answer: No. The CPT manual clearly states that 44139 (mobilization [take-down] of splenic flexure performed in conjunction with partial colectomy [list separately in addition to primary procedure]) should be used with the following:

44140 colectomy, partial; with anastomosis
 44141 ... with skin level cecostomy or colostomy
 44143 ... with end colostomy and closure of distal segment (Hartmann type procedure)
 44144 ... with resection, with colostomy or ileostomy and creation of mucofistula
 44145 ... with coloproctostomy (low pelvic anastomosis)
 44146 ... with coloproctostomy (low pelvic anastomosis), with colostomy
 44147 ... abdominal and transanal approach.
 
These are the only codes to which 44139 may be added. When describing add-on codes, the CPT manual typically lists all the codes to which an add-on code may be added (unless the add-on code can be added to many codes). Furthermore, 44139 clearly mentions a partial (as opposed to total) colectomy. As a result, billing 44139 with 44150 (colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy) is incorrect. This also makes sense clinically. Because a total colectomy involves removing all of the colon, the splenic flexure would be mobilized in any case, and the work involved in doing so is likely already incorporated into the value of the procedure.

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