General Surgery Coding Alert

Question: The surgeon laparoscopically identified a segment of the small bowel that appeared necrotic extending from just distal to the cecum back to the jejunoileal junction. He chose a proximal resection margin well away from the necrotic tissue and opened an avascular window in the mesentery and continued the dissection to the mid ascending colon. The surgeon submitted both small bowel and cecum sections for pathology. Should I code two bowel resections since the surgeon submitted both small bowel and cecum sections for pathology?

Answer: No, you should not report two bowel resections based on this op note. Although the note mentions submitting both small bowel and cecum sections for pathology, it appears that the surgeon performed just one bowel excision, not two separate excisions of a piece of small bowel and a piece of colon.

You don't provide the entire op note, but if the closure was an ileocolostomy, the appropriate code for the surgeon's work would be 44205 (Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy).

CPT also provides the following codes for laparoscopic partial colectomy, depending on the closure, as follows:

• 44204 -- ... colectomy, partial, with anastomosis
• 44206 -- ... colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure)
• 44207 -- ... colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)
• 44208 -- ... colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy.