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Listed below are the ICD-9-CM diagnosis and
procedure codes as well as the CPT-4 procedure codes that
we think properly classify this episode of treatment. Please
note that modifiers, used only for physician billing purposes,
have not been assigned to the CPT-4 codes.
Procedures
Exploratory laparotomy, lysis
of adhesions, Hartmann's procedure with end colostomy
Codes
and Rationale
This patient was admitted to the hospital
with persistent acute diverticulitis. Following treatment
the patient was scheduled for Hartmann procedure with end
colostomy. The diagnosis of acute diverticulitis is coded
in ICD-9-CM to 562.11, Diverticulitis of colon (without
mention of hemorrhage).
The surgery included exploratory laparotomy,
lysis of adhesions, and Hartmann procedure with end colostomy.
Because the exploratory laparotomy was an operative approach,
no ICD-9-CM code is assigned for this procedure. However,
two ICD-9-CM codes are required to describe the Hartmann procedure
and end colostomy. The Hartmann procedure is coded to 45.75,
Left hemicolectomy, and because documentation does
not specify whether the colostomy is temporary or permanent
to code 46.10, Colostomy, not otherwise specified.
The surgeon has included adhesions in the
postoperative diagnosis and has also listed lysis of adhesions
as part of the operative procedure. The report documents that
the small bowel was fixed to the sigmoid colon, and the sigmoid
colon was found to form a large mass which was fixed to the
lateral abdominal wall. At several points in the text of the
report, the surgeon states that dissection of these adhesions
proceeded slowly. Because the adhesions presented an obstacle
to the surgery and had to be lysed before the surgeon could
proceed with the Hartmann procedure, 54.5, Lysis of peritoneal
adhesions, should be included in the procedure codes.
568.0, Peritoneal adhesions (postoperative) (postinfective),
should also be added as a secondary diagnosis code.
In CPT-4, the Hartmann procedure and end colostomy
are covered by a single code, 44143, Colectomy, partial
with end colostomy and closure of distal segment (Hartmann
type procedure). Lysis of adhesions and exploratory laparotomy
do not require CPT-4 codes since they were done in conjunction
with the Hartmann procedure and colostomy rather than as separate
procedures.
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