The patient presented with small bowel obstruction secondary to malrotation and underwent repair of malrotation and lysis of Ladd’s bands. The Ladd’s surgery involves incision into the peritoneum, manipulation of the bowel, lysis of adhesions and appendectomy. In ICD-9-CM Index to procedures “Ladd operation” is indexed to code 54.95, Incision of peritoneum, however, this code assignment does not seem to capture the complete surgery. Should only code 54.95 be assigned? What are the appropriate procedure code assignments for this case?
The following codes should be assigned for Ladd’s surgery: 54.95, Incision of peritoneum; 46.81, Intra-abdominal manipulation of small intestine; 46.82, Intra-abdominal manipulation of large intestine; 54.59, Other lysis of peritoneal adhesions; and 47.19, Incidental appendectomy. Although the Ladd’s procedure is indexed to code 54.95, this code only covers one component of the procedure, so the additional codes are needed to fully capture the surgery that was performed. A classic Ladd procedure usually involves reduction of volvulus (if present), division of mesenteric bands, mobilization of small bowel on the right and large bowel on the left of the abdomen, and appendectomy.