tci General Surgery Coding Alert - 2008 Issue 9

Reader Questions: Approach Is Crucial for Fistula Repair

Question: I find two codes in CPT for repair of ileoanal pouch fistula/sinus that differ only according to the approach the surgeon uses. How can I differentiate between the two? Minnesota Subscriber Answer: Check the procedure notes carefully. If the surgeon states that during surgical preparation he prepped the abdomen and perineum, that's a tip-off for a combined approach as described by 46712 (Repair of ileoanal pouch fistula/sinus [e.g., perineal or vaginal], pouch advancement; combined transperineal and trans-abdominal approach). Be sure that you pay attention, however, to where the surgeon then places the incisions. Sometimes, the surgeon will...

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