AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2026 Issue 2; Ask the Editor
Ghost Ileostomy
A patient with complicated diverticulitis of the sigmoid colon and a small pericolonic abscess was admitted for a laparoscopic sigmoidectomy with colorectal anastomosis. Once the sigmoidectomy and anastomosis were completed, a small anastomotic leak was found and repaired. A repeat exam showed no leak or bleeding at the anastomosis site. The provider then decided to create a “ghost” ileostomy. An opening was created in the terminal ileum mesentery to access the ileal loop, which was then passed through an abdominal incision at the potential site of the stoma and secured to the abdominal wall with enough slack to allow normal bowel function. Is the creation of a ghost ileostomy, also referred to as a potential ileostomy, coded separately or considered inherent to the laparoscopic sigmoidectomy? If reported separately, what is the correct ICD-10-PCS code assignment? ...
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Article Overview
This coding article addresses an intraoperative scenario involving laparoscopic sigmoidectomy with colorectal anastomosis and a subsequent ghost ileostomy, also called a potential ileostomy. It focuses on ICD-10-PCS assignment questions, including whether the ileostomy creation is inherent to the primary procedure or separately coded. The content is relevant to hospital inpatient coders, CDI professionals, and surgical coding staff working with colorectal surgery documentation.
Why This Topic Matters
Correctly identifying whether an additional bowel-related step is separately reportable can affect ICD-10-PCS procedure reporting and the completeness of inpatient surgical coding.
What You Will Learn
- How this article frames a reportability question in inpatient procedural coding.
- What kind of operative scenario the article is discussing.
- Why the distinction between primary surgery and additional procedure reporting matters for ICD-10-PCS.
- The general type of code assignment issue raised by a ghost ileostomy case.
Who Should Read This
- Hospital inpatient coders
- Clinical documentation integrity specialists
- Surgical coding staff
- Revenue cycle professionals
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