General Surgery Coding Alert

Question: What is the difference between a tube and non-tube ileostomy? When can we charge for an ileostomy? The doctor did a laparoscopic colectomy and states, "I decided on a diverting ileostomy to protect the anastomosis." Is this the time to add the ileostomy?

Connecticut Subscriber

Answer: You should avoid using the term "tube ileostomy" all together. An ileostomy is when a loop of ileum is brought up to skin level and opened to divert the fecal stream. Alternatively, a surgeon may insert a feeding tube into the jejunum, or more rarely the ileum, for post-op feeding. While technically this is an ileostomy, (a hole in the ileum), this is not clinically referred to as an ileostomy.

The description your surgeon provided sounds like a standard diverting ileostomy. Look at code 44187 (Laparoscopy, surgical; ileostomy or jejunostomy, non-tube) in addition to the colectomy code you report. CPT bundles the ileostomy with total colectomy (such as 44150, Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy), but not with a partial (such as 44140, Colectomy, partial; with anastomosis). Therefore, if the surgeon performed a partial colectomy, you can report both and 44187.