General Surgery Coding Alert

Question: How should I code repair of an ileoanal pouch fistula?

New Mexico Subscriber

Answer: The correct answer depends on the approach your surgeon uses to access the fistula.

For a transperineal approach, report 46710 (Repair of ileoanal pouch fistula/sinus [e.g., perineal or vaginal], pouch advancement; transperineal approach). If the surgeon instead uses a combined transperineal-transabdominal approach, report 46712 (- combined transperineal and transabdominal approach).

The approach distinction isn't trivial, either clinically or in terms of reimbursement. The "double" approach pays 36.32 physician work relative value units instead of just 17.01 physician work RVUs for the transperineal approach (a difference of more than $730).

Helpful hint: If the surgeon's op note documents that she prepped the "abdomen," along with the perineum, you are probably looking at the combined approach (46712). But read carefully, because surgeons will sometimes prep both areas but may use different incisions (and the single approach, 46710), depending on information that becomes available during exploration.