General Surgery Coding Alert

Question: The surgeon performed a small bowel resection, placing bowel clamps at proximal and distal resection margins surrounding necrotic tissue. The surgeon then reanastomosed the small bowel by opening an enterotomy in both the proximal and distal end. Should we report this as 44120 and 44121 for an additional resection?

Answer: No, the correct coding for this case is simply 44120 (Enterectomy, resection of small intestine; single resection and anastomosis).

The surgeon removed only one necrotic bowel section. If the patient had multiple necrotic bowel sections and the surgeon removed each section, you would report +44121 (... each additional resection and anastomosis [list separately in addition to code for primary procedure]) for each subsequent section.

Don't count anastomosis: You might be confused by the fact that the surgeon identified and placed clamps at two sites proximal and distal to the necrotic area. Remember that you will always have a proximal and distal anastomosis for each bowel resection, so don't confuse the units of service for code selection by counting anastomosis. Instead, count the number of sections removed to determine if you should report 44120 plus additional units of +44121.