Doctor removed most of colon but not all. Proximally he transected the ileum a few cm proximal to the ileocecal valve, performed takedown of splenic flexure, and distal transection was mid sigmoid colon. Should I bill 44150 or 44160. I appreciate any input.
What wasn't mentioned above is if there was an anastomosis or not. I have a similar scenario.
"44150 - The physician removes the entire colon and performs an ileostomy or an anastomosis between the ileum and rectum. The physician makes an abdominal incision. Next, the colon is mobilized and the colorectal junction and terminal ileum is divided. The colon is removed. The terminal ileum is approximated to the rectum or brought out through a separate incision on the abdominal wall onto the skin as an ileostomy. The initial incision is closed."
"44160 - The physician makes an abdominal incision and removes a segment of the colon and terminal ileum and performs an anastomosis between the remaining ileum and colon. The physician makes an abdominal incision. Next, the selected segment of colon and terminal ileum are isolated and divided proximal and distal to the remaining bowel and removed. An anastomosis is created between the distal ileum and remaining colon with staples or sutures. The incision is closed."
Our provider is doing a "Subtotal colectomy and diverting ileostomy"
"After the patient underwent satisfactory anesthesia patient was placed in supine position. A colonoscope was introduced. There was no evidence of rectal mass. The colonoscope was advanced past the sigmoid colon to reveal severe lead dilated colon and ischemia of the mucosal surfaces. Scope was advanced to approximately the hepatic flexure where the colitis was most severe. Colonoscope was removed. We now proceed with midline laparotomy incision to perform subtotal colectomy for ischemic colitis. Ten blade scalpel used to make the incision from just below the xiphoid process to the pubic bone. Subcutaneous tissues were dissected using cautery. Fascial edges were opened along the length of the incision. Colon was extremely dilated and there was serosal tears of the cecum as well as splenic flexure. We now proceeded to mobilize the white line of Toldt from the sigmoid colon cephalad to the splenic flexure. We used cautery dissection for this. We now created a window on the mesenteric surface of the mid to distal sigmoid colon.
A GIA 75 with thick tissue load was used to transect the distal sigmoid colon. We now used Harmonic scalpel to take down rectal sigmoidal arterial branches. We stayed rather close to the colonic wall since this was not a malignancy. We proceeded our dissection up to the splenic flexure. We took down little colic adhesions with EnSeal device. Spleen was now delivered clear from the hepatic flexure. Hepatic flexure was now mobilized medially. We now took the greater omentum off the transverse colon with cautery dissection and EnSeal device. The middle colic vessels were ligated close to the colon wall with EnSeal device. We now proceeded to mobilize the white line of Toldt on the right pericolic gutter. The cecum appendix and terminal ileum were delivered medially. We mobilized our hepatic flexure with cautery dissection. The right colic artery was ligated with a 0 Vicryl tie. The remaining relatively avascular mesentery was taken down with the EnSeal device. We now created a window on the mesenteric surface of the terminal ileum 10 cm proximal to the cecum.
GIA 75 was used to transect the terminal ileum. Small ileo colic vessels were taken down with EnSeal. This completely freed up our: Specimen.
Specimen was delivered as subtotal colectomy. We irrigated the abdomen with approximately 6 L saline. The right and left pericolic gutter were irrigated thoroughly. The spleen was observed. There is no bleeding.
We now proceeded performed ileostomy. Terminal ileum was brought out through an incision in the right lower quadrant. There was no undue tension. All counts were correct. We now approximator fascial defect with multiple figure-of-eight 0 PDS sutures. Skin edges were loosely stapled. Two areas were packed in a wet-to-dry manner with Betadine soaked 4x4s.
We now performed Brooke ileostomy. We cut the staple line away from the terminal ileum. We now imbricated the terminal ileum to the skin edges with 3 0 Vicryl sutures. Stoma appliance was applied. Patient tolerated procedure without complications."
My coding consideration here is the 44144 - 52 - due to no mucofisutla creation (Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula). The lay description is as follows: The physician resects a segment of colon. The proximal and distal ends of colon are brought through the abdominal wall onto the skin as a colostomy and mucus fistula. The physician makes an abdominal incision. Next, the selected segment of colon is isolated and divided proximally and distally to the remaining colon and removed. The proximal end of colon or terminal ileum and the distal end of colon are brought through separate incisions on the abdominal wall onto the skin as an ileostomy or colostomy and mucus fistula. The initial abdominal incision is closed.
Expert Coding Opinion on this matter is greatly appreciated.
Respectfully,
Af, CPC