Urology Coding Alert

Question: How should I report the following surgery?

• 16-year-old boy with spina bifida with congenital fecal incontinence
• General surgeons perform a laparoscopic delivery of the appendix through the umbilical area with partial delivery of the cecum also through the umbilical area
• Urology surgeon came in and tailored the appendix for catheterizable stoma for fecal incontinence. The cecum was imbricated over the appendix to create a valve mechanism. The distal aspect of the appendix was transected. The appendix was catheterized with an 8 French feeding tube without difficulty. The cecum was delivered back into the abdomen.
• General surgery approximated the fascia, and performed fascial closure. Urology surgeon matured the stoma.

Washington D.C. Subscriber

Answer: For the general surgeon you would report the following:

• 44979 (Unlisted laparoscopy procedure, appendix) for the isolation and exposure of the appendix and part of the cecum.

For the urologist you should report the following:

• 50845 (Cutaneous appendico-vesicostomy) for the operation on the appendix and its cutaneous stoma formation. Append modifier 52 (Reduced services) since the urologist did not perform the complete procedure
• 44680 (Intestinal plication [separate procedure]) for the plication of the cecum, imbricated, to secure the valve mechanism.