bonnienorth55
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Hello all, Optum is denying 44146 that we billed for partial colectomy, anastomosis, and colostomy. Optum's denial was fairly vague and just states "a more accurate code should be used". I'm stumped on this one because going off the op report, that is the code that seems to be correct. I'm not sure if they're maybe just being picky with needing a more detailed portion of the report but would really appreciate a second set of eyes in case there's something I'm missing. Report listed below, thank you for any feedback! 
Technical Procedure(s): Procedure(s):
EXPLORATORY LAPAROTOMY WITH COLOSTOMY CREATION
Procedure Description:
The patient was brought to the OR, proper identification and procedure were confirmed with the initial
timeout. Patient was then prepped and draped in the usual sterile fashion. Final timeout protocol was then
followed and the surgery was started. Generous midline incision made carried into the abdominal cavity.
Upon entering the abdominal cavity encountered a grossly distended transverse colon and a small amount
of cloudy fluid in the pelvis. Upon further examination there was a clear perforation of the proximal rectum
with large amount of stool into the pelvis without contamination of the upper abdomen. The Bookwalter
retractor was put into place and the small bowel was packed into the upper abdomen as well as the
sigmoid colon and the cecum. I then chose a site for division of the sigmoid this was divided with the
contour stapler and then the mesentery was divided posteriorly taking the inferior mesenteric vessels
down to the distal portion of the perforation. Entered into the retrorectal lateral peritoneal attachments
were taken down we got down to what appeared to be healthy mid to low rectum. The contour stapler was
then fired across the rectum and the specimen was removed. At this point I had spent considerable time
irrigating the entire abdomen and pelvis. Once being satisfied with the irrigation a 19 French round Blake
drain was placed in the right lower quadrant stab incision down into the pelvis and secured to the skin with
3-0 silk. I then chose a site for the sigmoid colostomy circular incision was made on the skin. Into the
abdominal cavity. The proximal sigmoid was brought out through the ostomy site. The staple line was
removed. The stool balls that were in the sigmoid were removed through the ostomy. Was being satisfied
and there was no signs of any blockage the colostomy was matured with interrupted 3 oh silks. The
abdomen was then irrigated again with copious amounts normal saline. Fascia was closed with #1 PDS
from each incision across the middle and tied. Subcutaneous tissue was irrigated with normal saline and
then with lrrisept skin was closed surgical staples. Sterile dressings applied the operation was terminated.
Estimated Blood Loss: less than 100 ml
Drains: Yes - describe: 19 French round Blake drain into the pelvis
Specimens: Yes - describe: Proximal rectum
Complications: None noted at the time of surgery.
Disposition: PACU - hemodynamically stable.
Condition: stable
ED
Technical Procedure(s): Procedure(s):
EXPLORATORY LAPAROTOMY WITH COLOSTOMY CREATION
Procedure Description:
The patient was brought to the OR, proper identification and procedure were confirmed with the initial
timeout. Patient was then prepped and draped in the usual sterile fashion. Final timeout protocol was then
followed and the surgery was started. Generous midline incision made carried into the abdominal cavity.
Upon entering the abdominal cavity encountered a grossly distended transverse colon and a small amount
of cloudy fluid in the pelvis. Upon further examination there was a clear perforation of the proximal rectum
with large amount of stool into the pelvis without contamination of the upper abdomen. The Bookwalter
retractor was put into place and the small bowel was packed into the upper abdomen as well as the
sigmoid colon and the cecum. I then chose a site for division of the sigmoid this was divided with the
contour stapler and then the mesentery was divided posteriorly taking the inferior mesenteric vessels
down to the distal portion of the perforation. Entered into the retrorectal lateral peritoneal attachments
were taken down we got down to what appeared to be healthy mid to low rectum. The contour stapler was
then fired across the rectum and the specimen was removed. At this point I had spent considerable time
irrigating the entire abdomen and pelvis. Once being satisfied with the irrigation a 19 French round Blake
drain was placed in the right lower quadrant stab incision down into the pelvis and secured to the skin with
3-0 silk. I then chose a site for the sigmoid colostomy circular incision was made on the skin. Into the
abdominal cavity. The proximal sigmoid was brought out through the ostomy site. The staple line was
removed. The stool balls that were in the sigmoid were removed through the ostomy. Was being satisfied
and there was no signs of any blockage the colostomy was matured with interrupted 3 oh silks. The
abdomen was then irrigated again with copious amounts normal saline. Fascia was closed with #1 PDS
from each incision across the middle and tied. Subcutaneous tissue was irrigated with normal saline and
then with lrrisept skin was closed surgical staples. Sterile dressings applied the operation was terminated.
Estimated Blood Loss: less than 100 ml
Drains: Yes - describe: 19 French round Blake drain into the pelvis
Specimens: Yes - describe: Proximal rectum
Complications: None noted at the time of surgery.
Disposition: PACU - hemodynamically stable.
Condition: stable
ED