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Thanks in advance!
DIAGNOSIS: Prolapsed sigmoid colostomy.
PROCEDURE PERFORMED: Excision prolapsed colon with re-maturation and new
spot of end Brooke ileostomy.
ESTIMATED BLOOD LOSS: Minimal.
SPECIMEN: Right colon.
IMMEDIATE COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and
placed in the supine position on the operating room table. Time out session was
successfully conducted. The area was prepped and draped in the usual sterile
fashion. Incision was made around the colostomy itself and carried down through
subcutaneous tissue using Bovie electrocautery. The colostomy, the prolapsed
portion and the healthy portion were then freed entirely from the skin and was
advanced forward and approximately 4-5 inches in, the appendix was identified,
indicating the end of the colon. This was pulled entirely into the wound and
inspection of the colon revealed approximately 3-4 inches of healthy colon. I
consulted a colleague for an intraoperative consult to discuss whether or not
salvage of this colon was appropriate in this setting for possible reanastomosis in
the future. We had a discussion and the decision was made to create a new sited end
Brooke ileostomy as there was not sufficient colon for solid stool. The 10 mm
LigaSure was then used to take down the mesocolon to the level of the cecum. A
GIA-75 stapler was then used to come across the terminal ileum proximal to the
ileocecal valve in preparation for creation of the ostomy. This specimen was sent
as right colon with prolapsed right colon intussusception. A place was chosen
cephalad to the old site as it was herniated and was not good for the ostomy
caliber. A small circular incision was made and a cruciate incision was made
through the rectus fascia itself until the ostomy was pulled through with the
Babcock. This was placed on the skin. The old ostomy site was sharply debrided. A
running looped 0 Prolene suture was used to close the fascia of the old ostomy site.
Staples were placed in the skin leaving a gap and it was packed with quarter inch
iodoform gauze. The ostomy was then matured on the skin with interrupted 3-0 Vicryl
sutures in a rosebud fashion. Ostomy device was placed and the procedure was
terminated. Needle, sponge and instrument counts were correct at the end of the
procedure. The patient tolerated the procedure well.
My point of concern is this:
44346: Does not mention relocating the stoma (especially converting to ileostomy)
44345: Does mention relocating the colostomy stoma, however this is now converted to an ileostomy.
Would I code closure of colostomy, partial resection of colon, ileostomy all separate?
That doesn’t seem right either…
Charge sheet shows: 44160, 44312
I am probably overthinking this. 😮
Please help!
Thank you for your time!
~Melissa
My surgeon took a patient to the OR and completed partial colectomy of the transverse and descending colon. The patient began having cardiac issues and the operation had to be halted prior to any anastomosis or stoma creation. They covered his open abdomen with a negative pressure dressing and towels and placed a drain then an airtight seal.
The next day he was taken back to the OR – negative pressure dressings removed and abdomen explored. They performed partial omentectomy, created end colostomy and matured it. the abdominal wound was packed with wet Kerlix and ABD pads.
Should I use code:
Day 1:
44141 with -53 to indicate the discontinuance of the initial procedure?
44139 mobilization of splenic flexure (clearly documented in op note)
97607 for negative pressure dressing
Day 2:
44320-58 or 44141-52-58 for the colostomy creation for?
49255 for omentemtectomy day 2?
Thank you in advance