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With in-depth and updated knowledge of payer rules and accurate assignment of CPT codes, modifiers, and diagnoses codes, medical billing and coding companies ensure clean submission of general surgery claims for correct payment. Laparoscopic-assisted colorectal surgery, widely performed in the U.S. for the treatment of colon cancer, is in the news in the fight against opioid use. MedPage Today recently reported on research which found that a single-dose, non-opioid was linked to improved outcomes in patients undergoing laparoscopic colorectal surgery.

On February 8, 2017, the Food and Drug Administration released an updated action plan to address the opioid crisis. This latest step includes efforts aimed at consumers and providers to reduce opioid abuse, addiction, and injury or death. Physicians can link to the FDA’s “Search and Rescue,” site to learn how to address drug misuse and abuse in their practices. A recent study by researchers at Baylor University Medical Center evaluated patients who underwent laparoscopic right colectomy and received the long-acting liposomal bupivacaine (EXPAREL). It was found that EXPAREL use resulted in significant reductions in opioid utilization, opioid-related adverse events, and mean length of stay, along with comparable or lower resource utilization and costs, especially for outpatient surgery. The team recommended the need for controlled trials to investigate these outcomes in order to expand use of this opioid-sparing pain-management intervention.

When it comes to getting paid, surgeons need to understand what should be included in an operative report from a coding, billing, and reimbursement point of view. The main considerations when it comes to reporting colorectal surgery are:

  • Whether laparoscopic or open
  • Partial colectomy – Hartmann’s procedure, low anterior resection (LAR)
  • Code 44140 vs code 44160
  • Total colectomy
  • Coding a colectomy with diverting ileostomy
  • Abdominal perineal resection (APR), and
  • Stoma creation, revision, and closure

Colorectal Surgery Codes 2017

The CPT codes for Colorectal Surgery differ based on whether the procedure is partial or total and are as follows:

Traditional open procedure

44140 Colectomy, partial; with anastomosis
44141 Colectomy, partial; with skin level cecostomy or colostomy
44143 Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)
44144 Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula
44145 Colectomy, partial; with coloproctostomy (low pelvic anastomosis)
44146 Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy
44147 Colectomy, partial; abdominal and transanal approach
44150 Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy
44151 Colectomy, total, abdominal, without proctectomy; with continent ileostomy
44155 Colectomy, total, abdominal, with proctectomy; with ileostomy
44156 Colectomy, total, abdominal, with proctectomy; with continent ileostom
44157 Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed
44160 Colectomy, partial, with removal of terminal ileum with ileocolostomy

Laproscopic procedure

44204 Laparoscopy, surgical; colectomy, partial, with anastomosis
44205 Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy
44206 Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure)
44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)
44208 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy
44210 Laparoscopy, surgical; colectomy, total, abdominal, without proctectomy, with ileostomy or ileoproctostomy
44211 Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (S or J), with loop ileostomy, includes rectal mucosectomy, when performed
44212 Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy
44213 Laparoscopy, surgical, mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (to be listed separately in addition to primary procedure

Avoid Confusion between Codes 44140and 44160

44140 is Open resection of a segment of colon with an anastomosis between the proximal and distal ends
44204 is Laparoscopic approach – sameprocedure
44160 is Partial colectomy – removal of a segment of the colon (right side or ascending) and the terminal ileum and includes performing an anastomosis between the remaining ileum and colon. Thus it is a right colectomy.
44160 is the correct code for a “standard right hemicolectomy,” which normally includes the removal of the ileum and the formation of an ileocolostomy.

The documentation must specifically mention the ileum removal and ileocolonostomy, or else 44140 may be incorrectly assigned.

Some procedures may be started laparoscopically but be converted to open. Similarly, there are challenges involves in coding a colectomy with diverting ileostomy, abdominal perineal resection (APR), and stoma creation, revision, and closure. With a reliable medical coding company, general surgeons would benefit from a team of AAPC-certified coders and billing specialists to handle these challenges. In addition to entering data and coding correctly with the right modifiers, these experts would also take care of posting payments, following up denials, and filing appeals. They will also notify their clients about missing elements or errors in documentation. Such support is crucial to prevent reporting errors and maximize reimbursement.