Loop colostomy cpt

Loop colostomy cpt DEFAULT

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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.

Sours: https://www.outsourcestrategies.com/resources/coding-colectomy-key-considerations-for-claim-submission.html
  • Colostomy for treatment of functional constipation in children: a preliminary report.

    PubMed

    Woodward, Mark N; Foley, Peter; Cusick, Eleri L

    2004-01-01

    Surgery is indicated in very few children with intractable functional constipation. A number of operations have been described with unpredictable outcome and significant morbidity. The authors present a series of 10 children who underwent a Hartmann procedure with end colostomy formation. Preoperative management, in addition to maximum conservative measures, included psychologic referral, rectal biopsy, transit studies, and contrast enemas. A standard Hartmann procedure was performed with on-table rectal washout, formation of a proximal sigmoidcolostomy, limited anterior resection of hypertrophic proximal rectosigmoid, and oversewing of the rectal stump. The series includes 10 pediatric patients (4 female, 6 male), in whom constipation was first reported at a median age of 3 years (range, 2 months-7 years) and surgical referral was made at 8 years (range, 1-14 years). Surgery was performed at a median age of 9.5 years (range, 2-15 years), and the median postoperative stay was 5 days (range, 4-9 days). Complications occurred in four patients (transient mild rectal discharge in 2, stomal prolapse in 1, and an unrelated small bowel obstruction in 1 patient with an additional Mitrofanoff stoma). Median postoperative follow-up was 31 months (range, 9-56 months), and the children and parents were all completely satisfied with the stoma. Colostomy formation is a potential surgical option for severe functional constipation with low associated morbidity and high patient satisfaction.

  • Outcomes of Colostomy Reversal in a Public Safety Net Hospital: The End or Beginning of a New Problem?

    PubMed

    Adam, Nadir; Rahbar, Shahrzad; Skinner, Ruby

    2015-10-01

    Colostomy reversals can be technically challenging and linked to significant morbidity. There is sparse evidence that evaluates outcomes after colostomy reversals performed by acute care surgeons. We performed a review of 61 colostomy reversals from January 2011 to January 2014. Colostomies for acute diverticulitis were predominate, n = 32 (52%). Traumatic colorectal injuries were n = 15, 25 per cent. Colorectal cancer was n = 8, 13 per cent. Sigmoid volvulus accounted for n = 2 cases. Abdominal sepsis from adhesions was n = 3. A rectal foreign body was for n = 1 case. The time to reversal was 360 ± 506 days. Completion of reversals was successful in 90 per cent of cases and protecting stoma use was in n = 12, (22%). Surgical site infections occurred in n = 20, patients (32%). Surgical site infections were prevalent in obese patients, (55%). Anastomotic leaks (ALs) occurred at 12 per cent, and were prevalent in obese, [obese (22%) vs nonobese (8%), P = 0.1]. The majority of AL n = 6, (85%) were in acute diverticulitis and trauma. There were no ALs in cases with protective diversion. No deaths occurred. The elective nature of colostomy reversals does not imply low morbidity. Obesity and major inflammatory processes were associated with major surgical complications. These data suggest that protective stomas should be applied liberally, particularly in high-risk cases.

  • Sigmoid volvulus in an adolescent girl: staged management with emergency colonoscopic reduction and decompression followed by elective sigmoid colectomy

    PubMed Central

    Patel, Ramnik V; Njere, Ike; Campbell, Alison; Daniel, Rejoo; Azaz, Amer; Fleet, Mahmud

    2014-01-01

    A case of acute sigmoid volvulus in a 14-year-old adolescent girl presenting with acute low large bowel obstruction with a background of chronic constipation has been presented. Abdominal radiograph and CT scan helped in diagnosis. She underwent emergency colonoscopic detorsion and decompression uneventfully. Lower gastrointestinal contrast study showed very redundant sigmoid colonic loop without any transition zone and she subsequently underwent elective sigmoid colectomy with good outcome. The sigmoid volvulus should be considered in the differential diagnosis of paediatric acute abdomen presenting with marked abdominal distention, absolute constipation and pain but without vomiting. Plain abdominal radiograph and the CT scan are helpful to confirm the diagnosis. Early colonoscopic detorsion and decompression allows direct visualisation of the vascular compromise, assessment of band width of the volvulus and can reduce complications and mortality. Associated Hirschsprung's disease should be suspected if clinical and radiological features are suggestive in which case a rectal biopsy before definitive surgery should be considered. PMID:25143313

  • Sigmoid volvulus in an adolescent girl: staged management with emergency colonoscopic reduction and decompression followed by elective sigmoid colectomy.

    PubMed

    Patel, Ramnik V; Njere, Ike; Campbell, Alison; Daniel, Rejoo; Azaz, Amer; Fleet, Mahmud

    2014-08-20

    A case of acute sigmoid volvulus in a 14-year-old adolescent girl presenting with acute low large bowel obstruction with a background of chronic constipation has been presented. Abdominal radiograph and CT scan helped in diagnosis. She underwent emergency colonoscopic detorsion and decompression uneventfully. Lower gastrointestinal contrast study showed very redundant sigmoid colonic loop without any transition zone and she subsequently underwent elective sigmoid colectomy with good outcome. The sigmoid volvulus should be considered in the differential diagnosis of paediatric acute abdomen presenting with marked abdominal distention, absolute constipation and pain but without vomiting. Plain abdominal radiograph and the CT scan are helpful to confirm the diagnosis. Early colonoscopic detorsion and decompression allows direct visualisation of the vascular compromise, assessment of band width of the volvulus and can reduce complications and mortality. Associated Hirschsprung's disease should be suspected if clinical and radiological features are suggestive in which case a rectal biopsy before definitive surgery should be considered. 2014 BMJ Publishing Group Ltd.

  • Severe delayed complication after percutaneous endoscopic colostomy for chronic intestinal pseudo-obstruction: A case report and review of the literature

    PubMed Central

    Bertolini, David; De Saussure, Philippe; Chilcott, Michael; Girardin, Marc; Dumonceau, Jean-Marc

    2007-01-01

    Percutaneous endoscopic colostomy (PEC) is increasingly proposed as an alternative to surgery to treat various disorders, including acute colonic pseudo-obstruction, chronic intestinal pseudo-obstruction and relapsing sigmoid volvulus. We report on a severe complication that occurred two months after PEC placement. A 74-year-old man with a history of chronic intestinal pseudo-obstruction evolving since 8 years was readmitted to our hospital and received PEC to provide long-standing relief. The procedure was uneventful and greatly improved the patient’s quality of life. Two months later, the patient developed acute stercoral peritonitis. At laparotomy, the colostomy flange was embedded in the abdominal wall but no pressure necrosis was found at the level of the colonic wall. This complication was likely related to inadvertent traction of the colostomy tube. Subtotal colectomy with terminal ileostomy was performed. We review the major features of 60 cases of PEC reported to date, including indications and complications. PMID:17465514

  • Severe delayed complication after percutaneous endoscopic colostomy for chronic intestinal pseudo-obstruction: a case report and review of the literature.

    PubMed

    Bertolini, David; De Saussure, Philippe; Chilcott, Michael; Girardin, Marc; Dumonceau, Jean-Marc

    2007-04-21

    Percutaneous endoscopic colostomy (PEC) is increasingly proposed as an alternative to surgery to treat various disorders, including acute colonic pseudo-obstruction, chronic intestinal pseudo-obstruction and relapsing sigmoid volvulus. We report on a severe complication that occurred two months after PEC placement. A 74-year-old man with a history of chronic intestinal pseudo-obstruction evolving since 8 years was readmitted to our hospital and received PEC to provide long-standing relief. The procedure was uneventful and greatly improved the patient's quality of life. Two months later, the patient developed acute stercoral peritonitis. At laparotomy, the colostomy flange was embedded in the abdominal wall but no pressure necrosis was found at the level of the colonic wall. This complication was likely related to inadvertent traction of the colostomy tube. Subtotal colectomy with terminal ileostomy was performed. We review the major features of 60 cases of PEC reported to date, including indications and complications.

  • Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loopcolostomy after low anterior resection for rectal carcinoma

    PubMed Central

    Geng, Hong Zhi; Nasier, Dilidan; Liu, Bing; Gao, Hua; Xu, Yi Ke

    2015-01-01

    Introduction Defunctioning loop ileostomy (LI) and loopcolostomy (LC) are used widely to protect/treat anastomotic leakage after colorectal surgery. However, it is not known which surgical approach has a lower prevalence of surgical complications after low anterior resection for rectal carcinoma (LARRC). Methods We conducted a literature search of PubMed, MEDLINE, Ovid, Embase and Cochrane databases to identify studies published between 1966 and 2013 focusing on elective surgical complications related to defunctioning LI and LC undertaken to protect a distal rectal anastomosis after LARRC. Results Five studies (two randomized controlled trials, one prospective non-randomized trial, and two retrospective trials) satisfied the inclusion criteria. Outcomes of 1,025 patients (652 LI and 373 LC) were analyzed. After the construction of a LI or LC, there was a significantly lower prevalence of sepsis (p=0.04), prolapse (p=0.03), and parastomal hernia (p=0.02) in LI patients than in LC patients. Also, the prevalence of overall complications was significantly lower in those who received LIs compared with those who received LCs (p

  • Comparison of Two Coronal Magnetic Field Models to Reconstruct a Sigmoidal Solar Active Region with Coronal Loops

    NASA Astrophysics Data System (ADS)

    Duan, Aiying; Jiang, Chaowei; Hu, Qiang; Zhang, Huai; Gary, G. Allen; Wu, S. T.; Cao, Jinbin

    2017-06-01

    Magnetic field extrapolation is an important tool to study the three-dimensional (3D) solar coronal magnetic field, which is difficult to directly measure. Various analytic models and numerical codes exist, but their results often drastically differ. Thus, a critical comparison of the modeled magnetic field lines with the observed coronal loops is strongly required to establish the credibility of the model. Here we compare two different non-potential extrapolation codes, a nonlinear force-free field code (CESE-MHD-NLFFF) and a non-force-free field (NFFF) code, in modeling a solar active region (AR) that has a sigmoidal configuration just before a major flare erupted from the region. A 2D coronal-loop tracing and fitting method is employed to study the 3D misalignment angles between the extrapolated magnetic field lines and the EUV loops as imaged by SDO/AIA. It is found that the CESE-MHD-NLFFF code with preprocessed magnetogram performs the best, outputting a field that matches the coronal loops in the AR core imaged in AIA 94 Å with a misalignment angle of ˜10°. This suggests that the CESE-MHD-NLFFF code, even without using the information of the coronal loops in constraining the magnetic field, performs as good as some coronal-loop forward-fitting models. For the loops as imaged by AIA 171 Å in the outskirts of the AR, all the codes including the potential field give comparable results of the mean misalignment angle (˜30°). Thus, further improvement of the codes is needed for a better reconstruction of the long loops enveloping the core region.

  • Comparison of Two Coronal Magnetic Field Models to Reconstruct a Sigmoidal Solar Active Region with Coronal Loops

    SciTech Connect

    Duan, Aiying; Zhang, Huai; Jiang, Chaowei

    Magnetic field extrapolation is an important tool to study the three-dimensional (3D) solar coronal magnetic field, which is difficult to directly measure. Various analytic models and numerical codes exist, but their results often drastically differ. Thus, a critical comparison of the modeled magnetic field lines with the observed coronal loops is strongly required to establish the credibility of the model. Here we compare two different non-potential extrapolation codes, a nonlinear force-free field code (CESE–MHD–NLFFF) and a non-force-free field (NFFF) code, in modeling a solar active region (AR) that has a sigmoidal configuration just before a major flare erupted from themore » region. A 2D coronal-loop tracing and fitting method is employed to study the 3D misalignment angles between the extrapolated magnetic field lines and the EUV loops as imaged by SDO /AIA. It is found that the CESE–MHD–NLFFF code with preprocessed magnetogram performs the best, outputting a field that matches the coronal loops in the AR core imaged in AIA 94 Å with a misalignment angle of ∼10°. This suggests that the CESE–MHD–NLFFF code, even without using the information of the coronal loops in constraining the magnetic field, performs as good as some coronal-loop forward-fitting models. For the loops as imaged by AIA 171 Å in the outskirts of the AR, all the codes including the potential field give comparable results of the mean misalignment angle (∼30°). Thus, further improvement of the codes is needed for a better reconstruction of the long loops enveloping the core region.« less

  • [Surgical complications of colostomies].

    PubMed

    Ben Ameur, Hazem; Affes, Nejmeddine; Rejab, Haitham; Abid, Bassem; Boujelbene, Salah; Mzali, Rafik; Beyrouti, Mohamed Issam

    2014-07-01

    The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence. A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 cases (reconfection of the colostomy: 1 case, restoration of digestive continuity: 1 case) and a strangulated parastomal hernia in 1 case (herniorrhaphy). The elective incision and the perineal disease were risk factors for the occurrence of prolapse stomial. Surgical complications of colostomies remain a rare event. Prolapse is the most common complication, and it is mainly related to elective approach. Reoperation is often required especially in cases of early complications, with usually uneventful postoperative course.

  • Plasma Composition in a Sigmoidal Anemone Active Region

    NASA Astrophysics Data System (ADS)

    Baker, D.; Brooks, D. H.; Démoulin, P.; van Driel-Gesztelyi, L.; Green, L. M.; Steed, K.; Carlyle, J.

    2013-11-01

    Using spectra obtained by the EUV Imaging Spectrometer (EIS) instrument onboard Hinode, we present a detailed spatially resolved abundance map of an active region (AR)-coronal hole (CH) complex that covers an area of 359'' × 485''. The abundance map provides first ionization potential (FIP) bias levels in various coronal structures within the large EIS field of view. Overall, FIP bias in the small, relatively young AR is 2-3. This modest FIP bias is a consequence of the age of the AR, its weak heating, and its partial reconnection with the surrounding CH. Plasma with a coronal composition is concentrated at AR loop footpoints, close to where fractionation is believed to take place in the chromosphere. In the AR, we found a moderate positive correlation of FIP bias with nonthermal velocity and magnetic flux density, both of which are also strongest at the AR loop footpoints. Pathways of slightly enhanced FIP bias are traced along some of the loops connecting opposite polarities within the AR. We interpret the traces of enhanced FIP bias along these loops to be the beginning of fractionated plasma mixing in the loops. Low FIP bias in a sigmoidal channel above the AR's main polarity inversion line, where ongoing flux cancellation is taking place, provides new evidence of a bald patch magnetic topology of a sigmoid/flux rope configuration.

  • A novel corrective approach to achieve satisfactory function of a 'sunk' colostomy.

    PubMed

    Siddique, K; Prud'Homme, G; Samuel, N; Avil-Griffiths, K; Offori, T

    2016-05-01

    Creation of gastrointestinal stomas is a common colorectal procedure associated with early or late complications, some of which demand advanced technical skills and expertise for optimal management. A 63-year-old male underwent a defunctioning loopcolostomy for locally advanced rectal cancer with liver metastasis. Three months later, he had developed a skinfold over his stoma that resulted in a horizontal skin crease traversing through the stoma, causing the stoma to 'sink' leading to obliteration of the stomal opening. This scenario led to ineffective attachment of a stoma appliance, resulting in painful peristomal ulcers. After excision of the anterior abdominal wall, assessment of colostomy opening was carried out, followed by closure of the subcutaneous tissues and drain fixation. An elevated colostomy with an adequate functional opening was seen after wound closure. The patient made an uneventful recovery and was discharged home. After 3 weeks, he had a fully opened, normally functioning colostomy and peristomal ulcers were almost healed. This case highlights the challenges of stoma management, its related risks, avoidance of delay in chemotherapy, a patient wish for early return to work, and the novel approach we adopted to deal with these issues.

  • Observations on early and delayed colostomy closure.

    PubMed

    Tade, A O; Salami, B A; Ayoade, B A

    2011-06-01

    Traditional treatment of a variety of colorectal pathologies had included a diverting colostomy that was closed eight or more weeks later during a readmission. The aim of this retrospective study was to determine the outcomes of early colostomy closure and delayed colostomy closure in patients with temporary colostomies following traumatic and non-traumatic colorectal pathologies. In this study early colostomy closure was the closure of a colostomy within three weeks of its construction, while delayed colostomy closure referred to closure after 3 weeks. Complete records of the 37 adult patients who had temporary colostomy constructed and closed between Jan. 1997 December 2003 for various colorectal pathologies were studied. Fourteen patients had early colostomy closure while 23 had delayed closure. In the early colostomy closure group there were 10 men and 4 women. The mean age of the patients was 28yr with a range of 18-65yr. Colostomies were closed 9-18 days after initial colostomy construction. There was no mortality. Morbidity rate 28.6% (4 out of 14). There were two faecal fistulas (14.3%). Twenty-three patients had delayed colostomy closure 8 weeks to 18 months after initial colostomy construction. These were patients unfit for early surgery after initial colostomy construction because of carcinoma, significant weight loss, or sepsis. There was no mortality. Morbidity rate was 26.1%. There were 3 faecal fistulas (13.2%). Outcomes following early colostomy closure and delayed closure were comparable. Patients fit for surgery should have early closure whilst patients who may have compromised health should have delayed closure.

  • A novel corrective approach to achieve satisfactory function of a ‘sunk’ colostomy

    PubMed Central

    Siddique, K; Prud’Homme, G; Samuel, N; Avil-Griffiths, K; Offori, T

    2016-01-01

    Introduction Creation of gastrointestinal stomas is a common colorectal procedure associated with early or late complications, some of which demand advanced technical skills and expertise for optimal management. Case History A 63-year-old male underwent a defunctioning loopcolostomy for locally advanced rectal cancer with liver metastasis. Three months later, he had developed a skinfold over his stoma that resulted in a horizontal skin crease traversing through the stoma, causing the stoma to ‘sink’ leading to obliteration of the stomal opening. This scenario led to ineffective attachment of a stoma appliance, resulting in painful peristomal ulcers. After excision of the anterior abdominal wall, assessment of colostomy opening was carried out, followed by closure of the subcutaneous tissues and drain fixation. An elevated colostomy with an adequate functional opening was seen after wound closure. The patient made an uneventful recovery and was discharged home. After 3 weeks, he had a fully opened, normally functioning colostomy and peristomal ulcers were almost healed. Conclusions This case highlights the challenges of stoma management, its related risks, avoidance of delay in chemotherapy, a patient wish for early return to work, and the novel approach we adopted to deal with these issues. PMID:27087345

  • Perineal colostomy: an alternative to avoid permanent abdominal colostomy: operative technique, results and reflection.

    PubMed

    da Silva, Alcino Lázaro; Hayck, Johnny; Deoti, Beatriz

    2014-01-01

    The most common injury to indicate definitive stoma is rectal cancer. Despite advances in surgical treatment, the abdominoperineal resection is still the most effective operation in radical treatment of malignancies of the distal rectum invading the sphincter and anal canal. Even with all the effort that surgeons have to preserve anal sphincters, abdominoperineal amputation is still indicated, and a definitive abdominal colostomy is necessary. This surgery requires patients to live with a definitive abdominal colostomy, which is a condition that modify body image, is not without morbidity and has great impact on the quality of life. To evaluate the technique of abdominoperineal amputation with perineal colostomy with irrigation as an alternative to permanent abdominal colostomy. Retrospective analysis of medical records of 55 patients underwent abdominoperineal resection of the rectum with perineal colostomy in the period 1989-2010. The mean age was 58 years, 40 % men and 60 % women. In 94.5% of patients the indication for surgery was for cancer of the rectum. In some patients were made three valves, other two valves and in the remaining no valve at all. Complications were: mucosal prolapse, necrosis of the lowered segment and stenosis. The abdominoperineal amputation with perineal colostomy is a good therapeutic option in the armamentarium of the surgical treatment of rectal cancer.

  • Revision of loopcolostomy under regional anaesthesia and sedation.

    PubMed

    Ng, Oriana; Thong, Sze Ying; Chia, Claramae Shulyn; Teo, Melissa Ching Ching

    2015-05-01

    Patients presenting for emergency abdominal procedures often have medical issues that cause both general anaesthesia and central neuraxial blockade to pose significant risks. Regional anaesthetic techniques are often used adjunctively for abdominal procedures under general anaesthesia, but there is limited published data on procedures done under peripheral nerve or plexus blocks. We herein report the case of a patient with recent pulmonary embolism and supraventricular tachycardia who required colostomy refashioning. Ultrasonography-guided regional anaesthesia was administered using a combination of ilioinguinal-iliohypogastric, rectus sheath and transversus abdominis plane blocks. This was supplemented with propofol and dexmedetomidine sedation as well as intermittent fentanyl and ketamine boluses to cover for visceral stimulation. We discuss the anatomical rationale for the choice of blocks and compare the anaesthetic conduct with similar cases that were previously reported.

  • Perineal colostomy: an alternative to avoid permanent abdominal colostomy: operative technique, results and reflection

    PubMed Central

    da SILVA, Alcino Lázaro; HAYCK, Johnny; DEOTI, Beatriz

    2014-01-01

    Background The most common injury to indicate definitive stoma is rectal cancer. Despite advances in surgical treatment, the abdominoperineal resection is still the most effective operation in radical treatment of malignancies of the distal rectum invading the sphincter and anal canal. Even with all the effort that surgeons have to preserve anal sphincters, abdominoperineal amputation is still indicated, and a definitive abdominal colostomy is necessary. This surgery requires patients to live with a definitive abdominal colostomy, which is a condition that modify body image, is not without morbidity and has great impact on the quality of life. Aim To evaluate the technique of abdominoperineal amputation with perineal colostomy with irrigation as an alternative to permanent abdominal colostomy. Method Retrospective analysis of medical records of 55 patients underwent abdominoperineal resection of the rectum with perineal colostomy in the period 1989-2010. Results The mean age was 58 years, 40 % men and 60 % women. In 94.5% of patients the indication for surgery was for cancer of the rectum. In some patients were made three valves, other two valves and in the remaining no valve at all. Complications were: mucosal prolapse, necrosis of the lowered segment and stenosis. Conclusion The abdominoperineal amputation with perineal colostomy is a good therapeutic option in the armamentarium of the surgical treatment of rectal cancer. PMID:25626931

  • Alleviating debilitating, chronic constipation with colostomy after appendicostomy: a case study.

    PubMed

    Baig, Mirza K; Boyer, Mary Lou; Marquez, Helen; Wexner, Steven D

    2005-12-01

    Severe chronic constipation is a debilitating condition. Patients not only experience infrequent bowel movements, but also are often frustrated by the sensation of incomplete evacuation; pain; straining; daily use of enemas; and continual concerns regarding diet, fluids, and medications. Diagnostic tests are performed to rule out organic causes of the condition. Common treatment options consist of dietary fiber supplementation, dietary instruction, adequate fluid intake, enemas, and laxatives; additional noninvasive management includes biofeedback training and botulinum toxin type A injections. Surgery is rarely recommended, although a select group of patients may benefit from antegrade continence enema procedure. A female patient presented with a history of long-standing constipation. When antegrade continence enema offered no improvement and other treatment measures failed, she underwent successful laparoscopic-assisted sigmoid resection and end colostomy. This approach may provide options for patients in similar circumstances.

  • Early elective colostomy following spinal cord injury.

    PubMed

    Boucher, Michelle

    Elective colostomy is an accepted method of bowel management for patients who have had a spinal cord injury (SCI). Approximately 2.4% of patients with SCI have a colostomy, and traditionally it is performed as a last resort several years after injury, and only if bowel complications persist when all other methods have failed. This is despite evidence that patients find a colostomy easier to manage and frequently report wishing it had been performed earlier. It was noticed in the author's spinal unit that increasing numbers of patients were requesting colostomy formation during inpatient rehabilitation following SCI. No supporting literature was found for this; it appears to be an emerging and untested practice. This article explores colostomy formation as a method of bowel management in patients with SCI, considers the optimal time for colostomy formation after injury and examines issues for health professionals.

  • Literature Review: Double-Barrelled Wet Colostomy (One Stoma) versus Ileal Conduit with Colostomy (Two Stomas).

    PubMed

    Gan, Jason; Hamid, Rizwan

    2017-01-01

    The aim of this literature review was to analyse the advantages and disadvantages of a traditional ileal conduit (IC) with separate colostomy technique compared to the outcomes of a double-barrelled wet colostomy (DBWC) technique. The former technique results in the formation of two stomas, and the latter results in the formation of one stoma. PubMed was searched electronically for articles on DBWC. Fifteen articles were retrieved and of them 13 were included in the literature review (350 patients). Of the articles, 3 directly compared DBWC to IC with colostomy. Review of 13 DBWC articles demonstrated perioperative mortality ranging between 0 and 11.1% and postoperative complications ranging from 0 to 100%. Three of the studies directly compared DBWC to IC with colostomy; median operating times and length of stay were shorter in DBWC patients (p < 0.001); 30-day morbidity was reported to either be lower in the DBWC group (p < 0.043) or to have no statistically significant difference. Rates of mortality, pyelonephritis, electrolyte disturbances and urinary anastomotic problems did not differ between the 2 groups. The DBWC technique inherently has a benefit over the IC with colostomy technique, as it requires only one stoma. This literature review supports the use of the technically less challenging DBWC technique as a viable alternative to the traditional IC with colostomy technique. © 2016 S. Karger AG, Basel.

  • Sours: https://www.science.gov/topicpages/s/sigmoid+loop+colostomy
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    Colostomy

    From there, it travels to your small intestine and then to your large intestine, or colon. Hours or days later, the indigestible residue leaves the storage area of your rectum via your anus, as stool. Stool typically stays loose and liquid during its passage through the upper colon. There, water is absorbed from it, so the stool gets firmer as it nears the rectum.

    The ascending colon goes up the right side of your body. The stool here is liquid and somewhat acidic, and it contains digestive enzymes. The transverse colon goes across your upper abdomen, and the descending and sigmoid colon go down the left side of your body to your rectum. In the left colon, the stool becomes progressively less liquid, less acidic, and contains fewer enzymes.

    Where your colon is interrupted determines how irritating to the skin your stool output will be. The more liquid the stool, the more important it will be to protect your abdominal skin after a colostomy.

    Risks of the procedure

    Getting a colostomy marks a big change in your life, but the surgery itself is uncomplicated. It will be performed under general anesthesia, so you will be unconscious and feel no pain. A colostomy may be done as open surgery, or laparoscopically, via several tiny cuts.

    As with any surgery, the main risks for anesthesia are breathing problems and poor reactions to medications. A colostomy carries other surgical risks:

    • Bleeding

    • Damage to nearby organs

    • Infection

    After surgery, risks include:

    • Narrowing of the colostomy opening

    • Scar tissue that causes intestinal blockage

    • Skin irritation

    • Wound opening

    • Developing a hernia at the incision

    Before the procedure

    If possible, be sure to discuss your surgical and postsurgical options with a doctor and an ostomy nurse (a nurse who is specially trained to help colostomy patients) before surgery. It may also help to meet with an ostomy visitor. This is a volunteer who has had a colostomy and can help you understand how to live with one. And, before or after your surgery, you may wish to attend an ostomy support group. You can find out more about such groups from the United Ostomy Associations of America or the American Cancer Society.

    During the procedure

    Depending on why you need a colostomy, it will be made in one of 4 parts of the colon: ascending, transverse, descending, or sigmoid.

    • A transverse colostomy is performed on the middle section of the colon, and the stoma will be somewhere across the upper abdomen. This type of surgery--often temporary--is typically performed for diverticulitis, inflammatory bowel disease, cancer, blockage, injury or a birth defect. In a transverse colostomy, the stool leaves the colon through the stoma before reaching the descending colon. Your stoma may have one or two openings. One opening is for stool. The second possible stoma is for the mucus that the resting part of your colon normally keeps producing. If you have only one stoma, this mucus will pass through your rectum and anus.

    • An ascending colostomy goes on the right side of your abdomen, leaving only a short part of the colon active. It is generally performed only when blockage or severe disease prevents a colostomy further along the colon.

    • A descending colostomy goes on the lower left side of the abdomen, while a sigmoid colostomy--the most common type--is placed a few inches lower.

    After the procedure

    You may be able to suck on ice chips on the same day as your surgery. You'll probably be given clear fluids the next day. Some people eat normally within two days after a colostomy.

    A normal stoma is moist and pink or red colored. When you first see your colostomy, it may appear dark red and swollen, with bruises. Don't worry. Within a few weeks, the color will lighten and bruises should disappear.

    The bandage or clear pouch covering your colostomy right after surgery probably won't be the same type that you'll use at home. Your colostomy will drain stool from your colon into this colostomy pouch or bag. Your stool will probably be more liquid than before surgery. Your stool consistency will also depend on what type of colostomy you have and how much of your colon is still active.

    In the hospital

    A colostomy requires a hospital stay of about 3 days to a week. Your stay will probably be longer if the colostomy was performed for an emergency. During your hospital stay, you'll learn to care for your colostomy and the appliance or pouch that collects your stool.

    Your nurse will show you how to clean your stoma. After you go home, you'll do this gently every day with warm water only. Then gently pat dry or allow the area to air dry. Don't worry if you see a little bit of blood.

    Use your time in the hospital to learn how to care for your colostomy. If you have an ascending or transverse colostomy, you will need to wear a slim, lightweight, drainable pouch at all times. There are many different types of pouches, varying in cost and made from odor-resistant materials.

    Some people with a descending or sigmoid colostomy can eventually learn to predict when their bowels will move and wear a pouch only when they expect a movement. They may also be able to master a process called irrigation to stimulate regular, controlled bowel movements.

    Before going home, be sure to talk with an ostomy nurse or other expert who can help you try out the equipment you'll need. What works best will depend on what type of colostomy you have; the length of your stoma; your abdominal shape and firmness; any scars or folds near the stoma; and your height and weight.

    Sometimes, the rectum and anus must be surgically removed, leaving what's called a posterior wound. In the hospital, you'll use dressings and pads to cover this wound, and you may also take sitz baths--shallow, warm-water soaks. Ask your doctor and nurse how to care for your posterior wound until it heals. If problems should occur, please contact your doctor. 

    At home

    The skin around your stoma should look the same as elsewhere on your abdomen. Exposure to stool, especially loose stool, can be irritating. Here are some tips to protect your skin:

    1. Make sure your pouch and skin barrier opening are the right size.

    2. Change the pouch regularly to avoid leakage and skin irritation. Don't wait until your skin begins to itch and burn.

    3. Remove the pouching system gently, pushing your skin away instead of pulling.

    4. Barrier creams may be used if the skin becomes irritated despite these measures.

    Notify your doctor to report any of the following:

    • Cramps that last more than two hours

    • Continuous nausea or throwing up

    • Bad or unusual odor for more than a week

    • Change in your stoma size or color

    • Blocked or bulging stoma

    • Bleeding from the stoma opening or in the pouch

    • Wound or cut in the stoma

    • Serious skin irritation or sores

    • Watery stool for more than five hours

    • Anything unusual that concerns you

    A good rule is to empty your pouch when it's one-third full. And be sure to change the pouch before it leaks. As a general rule, change it no more than once a day, but not less than every three or four days.

    A colostomy represents a big change, but you will soon learn to live with it. Even though you can feel the pouch against your body, no one else can see it. Do not feel the need to explain your colostomy to everyone who asks; only share as much as you want to.

    Sours: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/colostomy
    A technique for emergent, decompressive loop colostomy – A video vignette

    Read colostomy, ileostomy documentation to identify separately reportable procedures

    JustCoding News: Inpatient, February 3, 2010

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    by Robert S. Gold, MD

    Coding for closure or takedown of colostomy or ileostomy requires close examination.

    Coders are somewhat adept at identifying codes V55.2 (attention to ileostomy) and V55.3 (attention to colostomy). This is a great start, but they must also capture the operation. For example, they must report ileostomy closure with 46.51 and colostomy closure with 46.52. This is where some coders make mistakes.

    Bowel ostomies may be temporary or permanent. The permanent ones typically are not closed later. Coders must understand why the temporary diversion occurred. Patients may have an obstruction, a perforation, or both. Regardless of which is present, there’s no time to prep the patient. And physicians can’t perform a bowel clean-out before initiating a life-saving operation.

    The small or large intestines most likely will include some stool. It will consist of some residual food that the patient recently ingested, but most of it will be bacteria.

    Performing a prepared bowel resection is risky even when a patient has undergone mechanical and antibacterial preparation of the intestine to make it as clean as possible. With an obstruction or perforation, there is no opportunity to prep the patient. Risks are present even when physicians are able to prepare a bowel.

    For example, there is a risk for anastomotic leak and wound infection when a physician preps a patient for a primary anastomosis after resection of a segment of intestine. With an unprepared bowel, it’s often too dangerous to consider a primary anastomosis, and a physician typically performs a diverting ostomy instead. This allows healing and permits an elective bowel prep to precede planned restoration of continuity of the intestinal tract.

    Physicians can create different types of stomas during the first operation. During a loop colostomy, the physician brings the large intestine upstream of the obstruction or perforation and through the abdominal wall—typically the transverse colon. The physician usually places the loop of the colon on top of the skin through a hole punched in the full thickness of the abdominal wall. The physician then places a glass rod at a 90º angle to the length of intestine so the bowel won’t slip back into the abdomen.

    Next, the surgeon transversely opens the intestine with an electrocautery and places a colostomy bag over the entire site. This bowel-opening procedure typically is performed in the recovery room or at the patient’s bedside several hours after the loop colostomy.

    Closing a loop colostomy involves opening the original incision. The opening in the transverse colon may be sutured shut and returned into the abdomen or may be resected. The bowel is returned to the abdominal cavity.

    Physicians sometimes perform a resection of a portion of the intestine. This may occur when patients have cancer or a perforation with abscess. Physicians may perform a proximal colostomy with a distal mucus fistula.

    During a proximal colostomy, the physician takes the portion of the intestine that was in front of the bad part and places it on the abdominal wall, typically through a stab wound on one side of the midline incision. The physician then brings the other open end beyond where the bad part was removed and places it on the abdominal wall, often through the lower end of the midline incision.

    Closing this type of colostomy requires that the surgeon resect the pieces of the intestine that went through the abdominal wall onto the skin. Physicians usually anastomose fresh-cut ends with sutures or some type of stapling technique (e.g., end-to-end, or side-to-side, functional end-to-end). These steps are all integral to colostomy closure. Code colostomy closure only.

    Documentation may reference a proximal colostomy with distal “Hartman’s pouch.” The colon (or small intestine) upstream from the damaged area is brought onto the skin surface through a stab wound to one side of the midline incision as an ostomy. The end downstream—the distal end—is stapled shut and dropped back into the abdominal cavity. Physicians perform this procedure when the diseased bowel includes the sigmoid colon, and the rectum is all that remains downstream. The physician closes the rectum and drops it back in because it can’t reach the abdominal wall.

    To close this colostomy, the physician clears the proximal (upstream) end of bowel (either colon or ileum) away from the skin. The physician dissects the piece of intestine that went through the body wall from the muscle and fascia and resects that piece of the intestine.

    The physician inserts an end-to-end anastomosis (EEA) stapling device into the rectum and advances it to the previous stapled closure of rectum in the belly. The physician places purse-string sutures, removes the previous staple line, and advances the device into the proximal segment. The surgeon tightens the EEA device, fires the staples, and removes the device through the anus.

    Surgeons often discuss observation of two intact “doughnuts.” Pathologic exam will confirm that the pieces of intestine were, indeed, intact. Coders should not report the resection of the part of the bowel that comprised the exteriorized colostomy or the doughnuts. Both are integral to the colostomy closure.

    Identify reimbursement implications
    Assigned codes affect reimbursement, so getting them right is important. For example, principal diagnosis code V55.3 and ICD-9 procedure code 46.52 map to MS-DRG 346 with a relative weight of 1.1881 in 2009. However, adding a resection of a portion of the colon (ICD-9 procedure code 45.79) results in MS-DRG 331, which has a relative weight of 1.6224 in 2009. That’s 33% more dollars.

    But don’t report conditions or procedures when doing so is inappropriate. Pieces of the intestine removed with colostomy closure or ileostomy closure are part of the operation and coders should not report either separately.

    Know the exception
    Only one exception exists—when the physician performs these procedures of true bowel resection separately. Occasionally, the physician performs a diverting colostomy as a life-saving operation, and then later, the patient returns to the operating room (OR) for resection of the offending segment of bowel, and the physician also closes the colostomy. In this situation, code the resection and colostomy closure separately.

    Another example occurs when a patient returns to the OR for a colostomy closure and the physician finds additional pathology. In addition to closing the colostomy, the physician may resect a portion of bowel with more diverticula, another mass, or something specifically identified and discussed in the operative report. Report each of these procedures separately.

    Read operative reports carefully
    Coders must read operative reports. Determine what the physician found and which procedures he or she performed. If documentation indicates the physician simply removed the small segment of bowel that had been exteriorized or examined the doughnuts associated with an end-to-end stapled anastomosis, don’t code it. When the physician actually performs a bowel resection, code it.

    See Coding Clinic, second quarter 1991, third quarter 1997, and first quarter 2009. They offer similar advice and provide additional guidance.

    Editor’s note: Dr. Gold is CEO of DCBA, Inc., a consulting firm in Atlanta that provides physician-to-physician programs in clinical documentation improvement. Reach him by phone at 770/216-9691 or by e-mail at[email protected].

    This article was originally published in the January issue of Briefings on Coding Compliance Strategies. E-mail your questions to Contributing Editor Lisa Eramo at [email protected]



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    Sours: http://www.hcpro.com/HIM-245886-3288/Read-colostomy-ileostomy-documentation-to-identify-separately-reportable-procedures.html

    Cpt loop colostomy

    What is the CPT code for colostomy?

    Current Procedural Terminology
    Preferred NameColostomy or skin level cecostomy
    IDhttp://purl.bioontology.org/ontology/CPT/44320
    ADDITIONAL GUIDELINE001: (For open procedure, use 44320)
    altLabelSkin level cecostomy Creation of large bowel drainage tract to skin surface COLOSTOMY/SKIN LEVEL CECOSTOMY Colostomy

    Click to see full answer.


    Regarding this, what is the CPT code for colectomy?

    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.

    Also Know, what is the CPT code for subtotal colectomy? : Payers may vary significantly in what charges they'll accept for this case, but for commercial payers, the following coding best represents the services provided: 44140-52 — Colectomy, partial; with anastomosis (Reduced services).

    Also Know, what is the CPT code for Sigmoidectomy?

    Under Laparoscopic Excision Procedures on the Intestines (Except Rectum) The Current Procedural Terminology (CPT) code 44204 as maintained by American Medical Association, is a medical procedural code under the range - Laparoscopic Excision Procedures on the Intestines (Except Rectum).

    What is a loop colostomy?

    A colostomy can be constructed as a loop colostomy or as an end colostomy. A loop colostomy is defined as a stoma in which the entire loop of colon is exteriorized and both the proximal limb and the distal limb open into the common stoma opening and are not transected.

    Sours: https://askinglot.com/what-is-the-cpt-code-for-colostomy
    Diverting Sigmoid Loop Colostomy

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