AHA Coding Clinic® for ICD-9 - 2014 Issue 1; Ask the Editor

Malone Antegrade Continence Enema (MACE) Procedure

A four-year-old boy presents to our facility due to imperforate anus and intractable constipation.  Laparoscopic-assisted Malone Antegrade Continence Enema (MACE) procedure was performed with V-Q-Y skin flap. During the procedure, the appendix was mobilized up to the umbilicus and delivered. The tip of the appendix was amputated and the appendix was then cannulated with the mentor catheter. The surgeon then made a subserosal tract in the tenia of the cecum with cautery and buried the appendix in this tract. Once this was completed, the appendix and cecum was returned to the abdomen and the appendiceal tip was delivered through the right lower quadrant incision. The incision was modified to create a V-Q-Y skin flap. The end of the appendix was spatulated and the skin flap anastomosed to the spatuled end to splay it open. The remainder of the flap was then closed and the Mentor catheter was secured to the skin. Coding Clinic, Third Quarter 2001, page 16, advises coders to assign code 47.99 for the MACE procedure. However, the MACE, Malone procedure and appendicostomy are all synonymous. What is the appropriate code assignment for this surgery? ...

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