I have had a provider tell me one time that the type of ostomy didn't matter. An ostomy is an ostomy. One is just more vogue than the other. In this case, I am sure it will be temporary and they will come back and close. In almost all cases for the Hartmann procedures, our providers do an ileostomy rather than a colostomy.
What about codes 44143, 44310 and 44139? There are no NCCI edits with these codes, but is it over the top? I do not see a colostomy documented, but as my provider has stated one ostomy is the same work as the other. I wonder about using only 44143 and 44139? Professional opinions requested.
PREOPERATIVE DIAGNOSIS: Obstructing splenic flexure colon carcinoma.
POSTOPERATIVE DIAGNOSES: Obstructing splenic flexure colon carcinoma plus cecal perforation.
PROCEDURE: Splenic flexure resection, right transverse colon resection, creation of Hartmann's pouch, creation of ileostomy.
DESCRIPTION OF PROCEDURE: The patient was placed on the operative table in supine position, general anesthesia was achieved. Foley catheter was placed. Abdomen was prepped widely with Betadine and draped in sterile fashion. An incision was made from the upper epigastrium, the left of the umbilicus and inferiorly. Skin and subcutaneous tissues were divided with a knife, taken to the fascial layer, which was incised in the midline. The abdominal cavity was entered. There was some serous ascitic-type fluid. This was aspirated with several 100 mL. The colon was markedly dilated in the transverse colon. There was some fecal smell. Upon palpation, liver did not have any specific mass notable. There was a fairly lar ge mass at the splenic flexure. The descending colon was actually fairly somewhat dilated as well. I was able to divide the peritoneal reflection in the left colon. This was then bluntly divided superiorly to the splenic flexure. The mass was somewhat into the mesentery and extended towards the inferior aspect of the spleen. The mid transverse colon was identified. This was encircled. Tissues were divided within the gastrocolic ligament creating only attachments to the mass. The distal colon was divided with stapling instrument, as well as the proximal colon to allow to mobilize the splenic flexure and the mass. Gradually we were able to do that with blunt dissection, as well as serial ties of the mesentery with Kelly clamps and 2-0 silk ties. Subsequently, this was retracted completely medially with only minimal attachments, which were divided between Kelly clamps and this was taken as en bloc specimen. There was one area that was somewhat oozing, I used a piece of Surgicel and packed that. Examined the inferior area of the cecum, it was distended. There was actually a serosal tearing and there was actually a small hole in that. 3-0 silk suture was placed in that. entered the right pericolic fold and this was taken superiorly around the hepatic flexure, allowing the entire right transverse colon to be mobilized into the incision. The mesentery was readily identified and divided between Kelly clamps and 2-0 silk ties and this was taken out en bloc. This had been done, we divided the terminal ileum as well. This was sent as a permanent specimen. The area was identified and a small amount of terminal ileum was resected to allow for mobility of the terminal ileum to bring out ileostomy. Subsequently, the abdomen was irrigated with 3 L saline solution. Aspirate was clear. There was good hemostasis. A circular incision made in the right lower quadrant, tissues were removed. Cruciate incision made into the fascia and this was entered into the peritoneum. A Babcock clamp was placed on the small bowel. This was doubly checked and confirmed it was not twisted. Fascia was closed with #0 Prolene suture, superior and inferior and tying at appropriate junction of middle inferior third. Subcutaneous tissues were irrigated, skin clips were applied, and a sponge Tegaderm dressing was applied. Subsequently, the ileum was opened and a Brooke ileostomy was matured with 4-0 Vicryl suture. Ostomy appliance was attached. The patient was taken to recovery room in a stable condition.
What about codes 44143, 44310 and 44139? There are no NCCI edits with these codes, but is it over the top? I do not see a colostomy documented, but as my provider has stated one ostomy is the same work as the other. I wonder about using only 44143 and 44139? Professional opinions requested.
PREOPERATIVE DIAGNOSIS: Obstructing splenic flexure colon carcinoma.
POSTOPERATIVE DIAGNOSES: Obstructing splenic flexure colon carcinoma plus cecal perforation.
PROCEDURE: Splenic flexure resection, right transverse colon resection, creation of Hartmann's pouch, creation of ileostomy.
DESCRIPTION OF PROCEDURE: The patient was placed on the operative table in supine position, general anesthesia was achieved. Foley catheter was placed. Abdomen was prepped widely with Betadine and draped in sterile fashion. An incision was made from the upper epigastrium, the left of the umbilicus and inferiorly. Skin and subcutaneous tissues were divided with a knife, taken to the fascial layer, which was incised in the midline. The abdominal cavity was entered. There was some serous ascitic-type fluid. This was aspirated with several 100 mL. The colon was markedly dilated in the transverse colon. There was some fecal smell. Upon palpation, liver did not have any specific mass notable. There was a fairly lar ge mass at the splenic flexure. The descending colon was actually fairly somewhat dilated as well. I was able to divide the peritoneal reflection in the left colon. This was then bluntly divided superiorly to the splenic flexure. The mass was somewhat into the mesentery and extended towards the inferior aspect of the spleen. The mid transverse colon was identified. This was encircled. Tissues were divided within the gastrocolic ligament creating only attachments to the mass. The distal colon was divided with stapling instrument, as well as the proximal colon to allow to mobilize the splenic flexure and the mass. Gradually we were able to do that with blunt dissection, as well as serial ties of the mesentery with Kelly clamps and 2-0 silk ties. Subsequently, this was retracted completely medially with only minimal attachments, which were divided between Kelly clamps and this was taken as en bloc specimen. There was one area that was somewhat oozing, I used a piece of Surgicel and packed that. Examined the inferior area of the cecum, it was distended. There was actually a serosal tearing and there was actually a small hole in that. 3-0 silk suture was placed in that. entered the right pericolic fold and this was taken superiorly around the hepatic flexure, allowing the entire right transverse colon to be mobilized into the incision. The mesentery was readily identified and divided between Kelly clamps and 2-0 silk ties and this was taken out en bloc. This had been done, we divided the terminal ileum as well. This was sent as a permanent specimen. The area was identified and a small amount of terminal ileum was resected to allow for mobility of the terminal ileum to bring out ileostomy. Subsequently, the abdomen was irrigated with 3 L saline solution. Aspirate was clear. There was good hemostasis. A circular incision made in the right lower quadrant, tissues were removed. Cruciate incision made into the fascia and this was entered into the peritoneum. A Babcock clamp was placed on the small bowel. This was doubly checked and confirmed it was not twisted. Fascia was closed with #0 Prolene suture, superior and inferior and tying at appropriate junction of middle inferior third. Subcutaneous tissues were irrigated, skin clips were applied, and a sponge Tegaderm dressing was applied. Subsequently, the ileum was opened and a Brooke ileostomy was matured with 4-0 Vicryl suture. Ostomy appliance was attached. The patient was taken to recovery room in a stable condition.