I have never run across this in my general surgery coding experience so I'm hoping someone can help me. This patient is in post op from a previous partial sigmoid colectomy followed up two days later with a total colectomy for a toxic mega colon and now presents back for a necrotic ileostomy. The op report will follow if anyone can please help me code this. I know I will need a modifier 78 but I have no idea what procedure code to use. Any help would be appreciated.
Procedure: Ileostomy exam under anesthesia, Superficial debridement of the mucosa of the ileostomy, Exam of ileostomy with anoscope.
Procedure description:
After informed consent was obtained from the patient's wife, the patient is brought to the operating room. He is placed in supine position. All of the dressings were removed from the abdominal wall as well as the ostomy device. The ileostomy was once more examined as using blunt dissection with gauze pads the overlying necrotic mucosa was peeled away. Underlying this necrotic mucosa was some pink tissue. At this time the decision was made to examine the ileum coming up to the ostomy using an anoscope. The ileum coming up through the subcuticular fat did appear to have pink coloring to it. It certainly did not appear grossly necrotic. The ostomy was digitized and there was a patent track down into the abdomen. At this point the mucosa was further debrided at the edge of the ileostomy to pink healthy tissue. A new ostomy appliance was applied around the ileostomy. A fresh moist dressing was applied over the laparotomy incision and previous sigmoid colostomy site. The patient was then taken back to the ICU.
Procedure: Ileostomy exam under anesthesia, Superficial debridement of the mucosa of the ileostomy, Exam of ileostomy with anoscope.
Procedure description:
After informed consent was obtained from the patient's wife, the patient is brought to the operating room. He is placed in supine position. All of the dressings were removed from the abdominal wall as well as the ostomy device. The ileostomy was once more examined as using blunt dissection with gauze pads the overlying necrotic mucosa was peeled away. Underlying this necrotic mucosa was some pink tissue. At this time the decision was made to examine the ileum coming up to the ostomy using an anoscope. The ileum coming up through the subcuticular fat did appear to have pink coloring to it. It certainly did not appear grossly necrotic. The ostomy was digitized and there was a patent track down into the abdomen. At this point the mucosa was further debrided at the edge of the ileostomy to pink healthy tissue. A new ostomy appliance was applied around the ileostomy. A fresh moist dressing was applied over the laparotomy incision and previous sigmoid colostomy site. The patient was then taken back to the ICU.