General Surgery Coding Alert

Question: How should I code an "en bloc" transverse colectomy with distal stomach, distal pancreas and spleen with vagotomy Roux-en-Y gastrojejunostomy and primary colonic anastomosis? This was done for a carcinoma of the transverse colon with involvement of the distal pancreas and stomach.

Iowa Subscriber
 
 Answer: The claim described should be coded:

43633 gastrectomy, partial, distal; with Roux-en-Y reconstruction
43635 vagotomy when performed with partial distal gastrectomy (list separately in addition to code[s] for primary procedure)
44140 colectomy, partial; with anastomosis
48140 pancreatectomy, distal subtotal, with or without splenectomy; without pancreaticojejunostomy.
As the highest-paid procedure, 48140 should be reimbursed at 100 percent. Both 43633 and 44140 will be reduced by 50 percent, following Medicare's multiple- surgery guidelines. However, as an add-on code, 43635 has a value that is already reduced; therefore, it should be paid at 100 percent.
 
Note: An "en bloc" resection refers to the removal of a single specimen composed of different organs or portions of organs with all the neoplasms involving the patient.  
You Be the Coder and Reader Questions were answered by Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C.; Barbara Cobuzzi, MBA, CPC, CPC-H, a coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J.; M. Trayser Dunaway, MD, FACS, a general surgeon in private practice in Camden, S.C.; Elaine Elliott, CPC, a general surgery coding and reimbursement specialist in Jensen Beach, Fla.; Diane Elvidge, CPC, a coding specialist with Princeton Reimbursement Group in Minneapolis; Kathleen Mueller, RN, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill.; and Jan Rasmussen, CPC, a general surgery coding and reimbursement specialist in Eau Claire, Wis.