Waiting for Colostomy Closure Pathology Results Can Optimize Payment
Published on Sun Oct 01, 2000
When a physician closes a colostomy, resection and anastomosis of the bowel may or may not be performed. Resection and anastomosis often accompany a closure. If the surgeon doesnt indicate that the resection was performed, coders should request the pathology report, if one is pending, before billing the procedure, as there is a large (almost five relative value units [RVUs]) difference between a simple colostomy closure and one involving resection and anastomosis.
Better yet, the surgeon should describe any resection and anastomosis performed with a colostomy closure during the same operative session by noting in the operative note, for example, takedown of colostomy with bowel resection and anastomosis. This will eliminate any possible confusion for the coder. Further, the location of the resection should be documented because resections performed in the colorectal area are reimbursed substantially higher than those performed in other sections of the bowel.
Colostomies sometimes are performed on patients with diverticulitis or an abdominal abscess. They also may be performed on cancer patients who have had colon resections to protect the area of anastomosis. The colostomy diverts the stool, which allows the wound to heal better and more safely.
Coding a Closure
Weeks or months after the initial procedure, the surgeon may decide to close the colostomy; often, a resection and anastomosis of the bowel also is performed. Depending on what the surgeon performed, the following codes may apply:
44620 closure of enterostomy, large or small intestine (16.38 RVUs); and
44625 with resection and anastomosis other than colorectal (21.14 RVUs); and
44626 with resection and colorectal anastomosis (e.g., closure of Hartmann type procedure) (34.71 RVUs).
If the colostomy is closed and no resection is performed, 44620 is used to code the procedure, which involves taking down the stoma of the colon and sewing it back together.
For example, a patient with colon cancer has a coloproctostomy with colostomy (44146, colectomy, partial; with coloproctostomy [low pelvic anastomosis], with colostomy). Three months later, the surgeon closes the colostomy. No resection is performed. This procedure would be coded 44620 because the surgeon did not remove any tissue, although anastomosis was performed to reconnect the opened section of colon that formed the colostomy.
Sometimes, however, resections are performed when colostomies are closed. The surgeon may locate an obstructing abdominal mass or lesion but decide to perform a colostomy to allow the dilated colon to resolve and only perform the resection (colectomy) when the colon has settled down.
If the resection is performed anywhere but the colorectal area (the sigmoid colon, for instance), the procedure would be coded 44625. If the colon is resected in the colorectal area (which is more difficult because the mass is in a deeper area [...]
