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General Surgery Coding Alert

You Be the Coder:

Colostomy/Colectomy

Published on Wed Aug 01, 2001

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.

Question: How should I code this session: end descending colostomy with mucous fistula; cholecystectomy; and release of small bowel obstruction secondary to adhesions to an area of probable abscess formation in the pelvis?

Arizona Subscriber

Answer: The answer depends on whether a section of the colon was removed, says Elaine Elliott, CPC, a general surgery coding and reimbursement specialist in Jensen Beach, Fla.
 
If no part of the colon was removed, 44320 (colostomy or skin level cecostomy; [separate procedure]) should be billed for the colostomy. If a partial colectomy was also performed, the procedure should be reported using 44144 (colectomy, partial with resection, with colostomy or ileostomy and creation of mucofistula). In either case, report 47600 (cholecystectomy) as well.
 
Neither the lysis of adhesions nor the release of the small bowel obstruction are separately payable -- regardless of whether 44320 or 44144 was performed -- because they are bundled to both codes.
 
If the lysis of adhesions was particularly difficult and required significantly more work than usual, modifier -22 (unusual procedural services) may be appended to either 44320 or 44144. If modifier -22 is appended, a paper claim should be submitted with documentation, including a short, simple paragraph explaining why additional payment is being sought. The carrier is unlikely to increase the fee if you don't ask for more reimbursement.

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