The patient presented several months ago with a strangulated inguinal hernia. At that time, the findings upon surgical exploration were active Crohn's disease with perforation of the sigmoid. He underwent sigmoid resection with creation of colostomy. The Crohn's disease is now controlled and the patient is admitted for reversal of Hartmann colostomy. The surgeon listed, "Partial colon resection, coloproctostomy (side to side anastomosis) and reversal of Hartmann colostomy," in the operative summary. In accordance with Coding Clinic Third Quarter 1997, pages 9-10, our hospital has been routinely coding "bowel resection" with colostomy closure. However, it seems that the bowel resection is inherent to the procedure. How should this case be coded?
Assign code V55.3, Attention to artificial openings, colostomy, as the principal diagnosis since the patient was specifically admitted for colostomy closure (aftercare). An encounter for aftercare management usually involves planned care. The aftercare V codes cover situations where the initial treatment of a disease or injury has been performed and the patient requires continued care during the healing or recovery phase. Code 555.9, Regional enteritis, unspecified site, should be assigned as an additional diagnosis.
Assign codes 46.52, Closure of stoma of large intestine, for the reversal of the colostomy, 45.79, Other and unspecified partial excision of large intestine, for the partial colon resection and 45.94, Large-to-large intestinal anastomosis, for the side to side anastomosis. In this case, code 45.94 was assigned because of the instructional note under category 45.7 that directs "Code also any synchronous anastomosis other than end-to-end (45.92-45.94)." In order to maintain coding accuracy and consistency, coders must be guided by the instructional notes.
When further resection of the colon is performed, an additional code is assigned for the partial colectomy. If, however, only minor trimming is done in order to freshen-up the edges of the colon for the anastomosis, it would be considered inherent to the total procedure and an additional procedure code is not assigned.