AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2016 Issue 3
Stoma Creation and Takedown Procedures
Bowel diversion surgery may be done to treat colorectal pathology, including but not limited to colon and rectal malignancies, diverticulitis, Crohn’s disease, ulcerative colitis, Hirschprung’s disease, and intestinal injury. Stomas are formed from the large intestine (colostomy) or from the small intestine (ileostomy); may be temporary or permanent; and can involve either an end stoma or a loop stoma. Stoma reversal surgery is also referred to as stoma closure and stoma takedown. In a Hartmann’s procedure or end colostomy, the diseased portion of the colon/rectum is excised, and the stoma is typically created on the left...
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Article Overview
This article covers common bowel diversion and stoma reversal procedures, including colostomy and ileostomy creation, stoma closure, and takedown approaches for different stoma types. It is aimed at coding professionals and clinicians who need to understand how these procedures are described in documentation and how they relate to ICD-10-PCS procedure classification concepts, including distinctions among procedure types and related surgical considerations.
Why This Topic Matters
Stoma creation and reversal procedures can be documented in several ways, and correct understanding of the surgical approach affects accurate coding and record interpretation. The article helps readers distinguish broad procedure categories and recognize when related surgical elements may or may not be treated as separate reporting considerations.
Article Sections
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Overview of bowel diversion surgery and stomas
Introduces bowel diversion surgery, major clinical contexts in which it is performed, and basic stoma types and reversal terminology.
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Hartmann’s procedure and end colostomy
Describes the general surgical setup and common clinical contexts associated with this type of stoma creation.
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Loop colostomy
Summarizes the broad anatomy and function of this temporary or protective diversion approach.
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End ileostomy
Covers the general circumstances and placement of this form of small-bowel diversion.
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Loop ileostomy
Explains the protective purpose and temporary nature of this type of ileostomy.
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Ileostomy closure and takedown
Discusses stoma reversal at a high level and its relationship to ICD-10-PCS concepts.
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Transverse or other loop colostomy reversal
Reviews the general approach to reversal of loop colostomies and related classification considerations.
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Closure of a Hartmann (end stoma)
Addresses the broader surgical complexity of closing an end stoma and the classification concept associated with this type of reversal.
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Parastomal hernia repair during takedown
Covers the scenario in which a hernia related to the stoma is repaired in conjunction with reversal surgery.
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Documentation and indexing cautions for coders
Provides general guidance on reviewing operative documentation rather than relying on an index entry alone.
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Clinical example
Presents a sample stoma takedown scenario with accompanying coding question and discussion of the documented surgery.
What You Will Learn
- How bowel diversion surgeries and stomas are generally described
- The broad categories of stoma creation and reversal procedures
- How different takedown scenarios are discussed in relation to ICD-10-PCS
- When related abdominal wall repair may be considered in the context of stoma reversal
- Why operative documentation review matters for procedure classification
Who Should Read This
- Medical coders
- Coding auditors
- Clinical documentation specialists
- Revenue cycle staff
- Surgeons and surgical staff
Codes Discussed
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