The patient underwent lysis of adhesions for small bowel obstruction. Because of the extensive dense adhesions, significant time was spent taking them down from the abdominal wall, pelvis, small bowel and colon. Multiple enterotomies were made dissecting the small intestine. A full thickness injury was identified in a section of small intestine, which could not be repaired primarily; therefore a portion of the small intestine was resected with side-to-side stapled anastomosis. The other enterotomies involving the small bowel were repaired with Lembert style sutures. At the close of the surgery, Seprafilm was placed in the abdomen and pelvis and the operative wound was reapproximated. Coding Clinic, Second Quarter 2007, pages 11-12, stated that a serosal tear should not be coded. In this case, however, the full thickness injury of the small bowel appears to be significant due to the fact that a partial resection of the small intestine was carried out to repair the injury. How should this case be coded?
Assign code 560.81, Intestinal or peritoneal adhesions with obstruction, as the principal diagnosis. Code 998.2, Accidental puncture or laceration during a procedure, and code E870.0, Accidental cut/puncture/perforation/hemorrhage during surgical operation, should also be assigned. For the procedures, assign code 54.59, Other lysis of peritoneal adhesions, code 45.62, Other partial resection of small intestine, code 45.91, Small-to-small intestinal anastomosis, code 46.73, Suture of laceration of small intestine, except duodenum, and code 99.77, Application or administration of adhesion barrier substance, for the placement of the Seprafilm.
This case involved more than a minor serosal tear. In this instance, the surgeon has clearly documented that the multiple enterotomies were clinically significant and a complication of the procedure.