General Surgery Coding Alert

Question: I'm trying to code a note titled "partial colectomy," in which the surgeon describes removing 10 inches of large intestine and connecting the bowel following the resection using a "low-pelvic anastomosis with temporary colostomy." How should I code this?

Indiana Subscriber

Answer: The first thing we need to know is whether the procedure is open or laparoscopic. The answer to that question will lead to two different code choices. Let's look at both options.

A low-pelvic anastomosis is the same procedure as a coloproctostomy, which means that the surgeon attaches the resected end of the colon to the rectum. If the surgeon choses to perform a temporary colostomy, that changes the coding as well.

If the procedure is open, you should report the service as 44146 (Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy). Distinguish that code from 44145 (...with coloproctostomy (low pelvic anastomosis)), which describes the same procedure without the colostomy.

If the surgeon performs the procedure laparoscopically, you should instead turn to 44208 (Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy). Again, be sure to distinguish that code from the similar code that does not include the colostomy: 44207 (...colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)).