AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2021 Issue 1; Ask the Editor

Kock Pouch Revision Surgery

A patient who had previously undergone total proctocolectomy with continent ileostomy (Kock pouch) presents for revision of the K-pouch due to leakage. Upon entering the abdomen, the surgeon noted a slipped nipple valve, which was only partially intussuscepted at its base. This area was reduced by making an anterior pouchotomy, and freeing staples on the intussusception of the nipple valve. The surgeon elected to construct a new nipple valve with the previous afferent limb and rotate the pouch. The nipple valve was resected, the bowel was divided, and the pouch rotated, such that the new nipple was going to the anterior abdominal wall and the previous nipple valve was inferior and would be the base for the afferent limb. The afferent limb was connected through the pouchotomy to re-establish continuity. The new nipple valve was intussuscepted and bowel-to-bowel apposition was done. The pouchotomy was closed incorporating a part of the nipple valve. What is the correct code assignment for Kock pouch revision with rotation? ...

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