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Coding Q&A: Extent, Bowel or Plastic

Coding ToolsAppendixColon and Small BowelFlaps and GraftsHysterectomyMultiple or Difficult ProceduresOmentumSurgeryVagina
Mar 15, 2021

Disclaimer: Answers to incoming questions are provided by the members of the Society of Gynecologic Oncology (SGO) Coding and Reimbursement subcommittee and represent their opinion based upon the current and usual practices in the field. Every effort is made to ensure the accuracy of the information provided. However, the information neither replaces information in Medicare regulations, the CPT-4 code book, or the ICD-10 CM code book; nor does it constitute legal advice. Responses to questions are intended only as a guide and are not a substitute for specific accounting or legal opinions. SGO expressly disclaims all responsibility and liability arising from use of, or reliance upon this information as a reference source, and assumes no responsibility or liability for any claims that may result directly or indirectly from use of this information, including, but not limited to, claims of Medicare or insurance fraud.

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How do you code for placement of a matrix or some protective covering in the pelvis during a pelvic exenteration?

Placement of matrix material in the pelvis to prevent bowel obstruction would be considered an inherent part of the procedure, and should not be billed separately. Therefore, you should report only code 58240 for the pelvic exenteration. An exception would be placement of an omental pedicle j-flap in the pelvis which is CPT code 49905+ and is an add on code to the primary procedure code of the pelvic exenteration.

 

Would it be appropriate to code construction of the vagina (57292) with pelvic exenteration (58240) or is the construction of the vagina bundled into the exenteration code?

Vaginal reconstruction with a skin graft is not included in the pelvic exenteration code (58240) and can be coded separately with CPT 57292. If muscle, myocutaneous, or fasciocutaneous tissue is used to reconstruct the vagina, then CPT code 15734 should be used.

 

How would you code a total pelvic exenteration if a colorectal surgeon performs the colon resection?

The CPT code for total pelvic exenteration is 58240. Colon resection and reanastomosis (44140) is bundled into the TPE code, so you cannot bill both together. The best way to code this is as co-surgeons. To do that both you and the colorectal surgeon bill 58240-62.

 

How do you code for a Hartmann procedure done in conjunction with a radical hysterectomy?

The Hartmann procedure is reported with code 44143. The 51 modifier (multiple procedure) should be appended to code 44143 as it has fewer RVUs than the radical hysterectomy (58210).

 

How do you code for an ileo-jejunal bypass anastamosis and drainage of small bowel fistula with malecot drain?

When you perform an internal bypass, the best CPT code would be 44130, enteroenterostomy with or without cutaneous enterostomy. The fistula drainage with placement of a drain would not be separately reported as it would be considered part of the primary procedure.

 

Can you code for an appendectomy if the reason it is being taken is to avoid possible appendiceal mucinous lesions?

Incidental appendectomy cannot be billed separately at the time of another intra-abdominal surgery. However, if there is disease of the appendix (i.e., tumor metastatic to the appendix or involvement with endometriosis), appendectomy maybe performed and billed with CPT +44955. This code is an add-on code to the primary procedure performed.

 

How should you code for an ileotransverse entero-colostomy without a bowel resection?

When you perform an internal bypass, the best CPT code would be 44130, enteroenterostomy with or without cutaneous enterostomy.

 

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