General Surgery Coding Alert

Question: How should I code the following open surgical case: The surgeon isolated the sigmoid colon using Endo-GIA: approximately 15 cm segment of sigmoid colon that was sufficient to reach the skin. Also, the left ureter was isolated and then taken down to the sigmoid conduit. The ureter was then cut and spatulated and the ends were then anastomosed to the sigmoid colon. Prior to closing the anastomosis a ureteral stent was passed through the distal aspect of the sigmoid conduit into the ureter and up into the kidney.

Oregon Subscriber

Answer: Based on the documentation, it appears that the surgeon creates the uretero-sigmoid colon urinary diversion using the sigmoid colon as the urinary conduit. You should report this portion of the procedure using 50810 (Ureterosigmoidostomy, with creation of sigmoid bladder and establishment of abdominal or perineal colostomy, including intestine anastomosis).

The surgeon also inserted a ureteral stent into the kidney, which you may be able to separately report. However, you would need to use an unlisted code, such as 53899 (Unlisted procedure, urinary system).