Coding Colectomy – Key Considerations for Claim Submission

by | Jan 10, 2019 | Medical Coding News, Resources

An operation to remove part of the intestine (bowel), colectomy is a common procedure performed by general surgeons and colon and rectal surgeons. Given the large number of individual procedure codes available for colectomy procedures, medical billing services are a practical option for surgeons to assign the right CPT codes, stay on top of regulations, and bill their services for maximum reimbursement. A reliable outsourcing firm specialized in general surgery medical billing and coding can help reduce claim rejections and minimize payment delays.

Colectomy – Indications and Types

A colectomy is performed to treat different types of conditions and diseases that may affect the intestines. These include:

  • Inflammatory bowel disease include ulcerative colitis and Crohn’s disease
  • Injury to the bowel, rectum or perineum
  • Ulcerative colitis
  • Crohn’s disease
  • Diverticulitis
  • Colorectal polyp
  • Colorectal cancer

There are different types of surgical procedures involving the colon:

  • Total colestomy – the entire colon is removed and the small intestine is connected to the rectum
  • Hemicolectomy – removing the right or left portion of the colon
  • Proctocolectomy – removing both the colon and rectum
  • Polypectomy – removing a cancerous polyp or polyps from the colon or rectum using a colonoscope
  • Sigmoidectomy – removal of the lower part of the colon which is connected to the rectum
  • Low anterior resection – removal of the upper part of the rectum to treat cancer
  • Abdominal perineal resection – the removal of the sigmoid colon, rectum and anus and construction of a permanent colostomy

There are three approaches to colon surgery: open, laproscopic repair, and robot-assisted laparoscopic resection. The type of operation performed depends on the condition, size of the diseased area or tumor, location, as well as considerations such as health, age, anesthesia risk. In open colectomy, a large incision is made in abdomen and the diseased part of the colon is removed. Laproscopic colectomy involves using a laproscope to perform the surgery through very small “keyhole” incisions in the abdomen.

CPT Codes for Colectomy

To assign the correct codes, experienced medical coders carefully examine the operative reports to determine what procedure or procedures the surgeon performed. The CPT codes for colectomy are as follows:

Traditional open procedure

  • +44139 Mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy
  • 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 ileostomy
  • 44157 Colectomy, total; abdominal, without proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed
  • 44158 Colectomy, total; abdominal, without proctectomy; with ileoanal anastomosis, creation of ileal reservoir (S or J), includes loop ileostomy, and rectal mucosectomy, when performed
  • 44160 Colectomy, partial; with removal of terminal ileum with ileocolostomy
  • 44320 Colostomy or skin level cecostomy
  • 44322 Colostomy or skin level cecostomy; with multiple biopsies (eg, for congenital megacolon) (separate procedure)
  • 44799 Unlisted procedure, small intestine
  • 45110 Proctectomy; complete, combined abdominoperineal, with colostomy
  • 45111 Proctectomy; partial resection of rectum, transabdominal approach
  • 45112 Proctectomy, combined abdominoperineal, pull-through procedure (eg, colo-anal anastomosis)
  • 45113 Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with or without loop ileostomy
  • 45114 Proctectomy, partial, with anastomosis; abdominal and transsacral approach
  • 45119 Proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy when performed
  • 45120 Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with pull-through procedure and anastomosis (eg, Swenson, Duhamel, or Soave type operation)
  • 45121 Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with subtotal or total colectomy, with multiple biopsies
  • 45123 Proctectomy, partial, without anastomosis, perineal approach
  • 45399 Unlisted procedure, colon

Laparoscopic 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)
  • 442Ø7 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)
  • 442Ø8 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anatomosis) with colostomy
  • 4421Ø 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
  • 44238 Unlisted laparoscopy procedure, intestine (except rectum)
  • 45395 Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, with colostomy
  • 45397 Laparoscopy, surgical; proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy, when performed
  • 45499 Unlisted laparoscopy procedure, rectum

Coding Guidance

The Michigan Surgical Quality Collaborative (msqc.org) points out that for the CPT codes that pertain to colectomy, the key elements to look for when assigning the CPT codes are:

  • Approach
  • Anatomical locations or areas of the resection/stapling lines
  • Anastomosis versus Creation of stoma (some procedures use both)
  • Complexity of the procedure

In the Bulletin of the American College of Surgeons dated June 1, 2018, one question in the FAQ section was:

“How do I report an open colon resection and colorectal anastomosis with loop ileostomy for fecal diversion”?

The answer: “You should report CPT code 44146 (see Table 1). Although the CPT descriptor includes the term “colostomy,” the Medicare physician fee schedule work relative value unit (RVU) for this code is based on creation of either a colostomy or an ileostomy. If this same procedure was performed laparoscopically, the correct code to report would be 44208, Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy. It is incorrect to report a code for ileostomy or jejunostomy (44310 or 44187) with a partial colectomy code (for example, 44145 or 44207) for this procedure, as doing so would be unbundling”.

While general surgeons perform a wide range of operations, assigning CPT codes to report even common clinical scenarios can be difficult. Coders in a reliable medical billing and coding company will examine the clinical documentation carefully and assign the right codes to capture the operation, identify separately reportable procedures, and more.

How to Ensure Efficient Dental Insurance Verification and Claim Submission

How to Ensure Efficient Dental Insurance Verification and Claim Submission

by | Apr 18, 2016 | Insurance/ Eligibility Verification

Dental insurance verification is the important first step in your dental medical billing cycle to ensure that the dental services you offer are paid. Almost 75% of dental insurance claims have issues with reimbursement due to insurance eligibility being incorrectly assessed. Dental facilities need to get the insurance verification process accurate.

Comprehensive Verification and Accurate Claim Submission

A few measures could help ensure you minimize claim denials. One of the primary tips is to take all the required effort to correctly send the claim the very first time. While this instruction may seem pretty obvious, it is often the case that claims are incomplete. Do not wait for information to be requested before it is sent, which often seems to be happening.  That’s why you need to have a proper verification system in place:

  • Sometimes outsourcing insurance verification could be a good thing, since the outsourcing provider would not be relying on the information provided by the patient alone. Whatever be the method you choose to verify, ensure that the claim is sent to the right place.
  • Make sure that you send x-rays connected with all the implants, crowns, pre-procedure and post-procedure root canals, root planing and scaling. For the SRP (Scaling and Root Planing) procedure, a perio chart is required. For any major treatment, the submitted information should include narratives in the clinical notes so that it can be easily accessed. Only 150 character spaces can get electronically submitted in the Remarks for Unusual Services section.
  • In the case of crowns, it must be documented whether the procedure involves an initial crown or a replacement crown. With a replacement crown you also need to mention the exact date when the initial placement took place, without making it up or coming up with a wild guess. This is tough if the initial procedure did not occur at your facility. You need the support of your patient here. Secure the support by explaining to the patient that they would not receive insurance coverage on the crown unless the date of the initial crown is provided.
  • It is also important to remember that some insurance companies would only pay for the crown procedure after the seating of the permanent crown. So you must keep track of the stages so that you can submit the updated information as soon as the permanent seating is done.
  • You must also ensure that outstanding claims are tracked on a week-by-week basis. You know that clearing houses usually provide you with a status report after claim submission. Make sure that you study these reports each day so you can get insights on the claim status and the reason why the claim was not processed satisfactorily. Checking these out is better than waiting for the EOB (explanation of benefits) to arrive, by which time you would already be 30 days into the claim. Also keep checking the insurance websites as they provide a good deal of information on tracking outstanding claims.
  • Strangely, statistics state that 85% of denied procedures do not get appealed. This is a big mistake, especially considering that 75% of the appealed procedures are reprocessed with payment. If you feel that a denied procedure must be paid you must send it back to be reprocessed, and this also applies for crown buildups forming part of crown prep. Make sure you mention the reason for appeal in a detailed manner.

Information Required for Successful Verification

For all these steps to be successful, it begins with comprehensive insurance verification. A dental facility needs to have comprehensive information on various aspects of insurance eligibility to ensure that the patient has coverage for the procedure that is to be performed. This must include information such as:

  • The dates for which the coverage is effective
  • The codes specific to the procedure to be performed
  • The waiting period which is sometimes required for certain procedures to ensure they are covered
  • The type of plan and the fee schedules
  • Maximums and deductibles
  • Required documentation
  • Information regarding claim submission such as phone number, address, payer ID, and fax number
  • Coverage percentage by category
  • Coverage for tooth implant
  • Coverage for tooth grafting
  • Coverage for crowns, cleanings and build-ups
  • Frequencies for panoramic and full mouth x-rays
  • Missing tooth clause
  • Last date of service

With these bits of data in place, you can also get accurate estimates created for your patients and secure their trust.

Outsourcing dental insurance verification will bring in experienced professionals to handle the various aspects of verification. It would also give you access to smart digital tools that can speed up and improve your verification process – tools that can ensure quick and real-time eligibility verification, improved patient communications, and increased case acceptance.