Colostomy- PCS Coding

Question: Based on the dictated Operative report, do I need further specificity to code the colostomy?

Operative report:
Procedure Performed

1. Exploratory laparotomy

2. Abdominoperineal resection
Described in the body of the report:

The area on the sigmoid colon was transected with a GIA 100 stapler and at this point, dissection was carried out in the perineal area.

Once this was completed, a left mid quadrant colostomy was fashioned which was marked preoperatively by excising a disc of skin, deepening it down through the subcutaneous tissues, opening the fascia in a cruciate type fashion and then placing a Mayo scissors through the fibers of the rectus muscle and poking full-thickness through the abdominal wall. Once this was done, it was dilated 2 fingerbreadths. The bowel was brought through after some of the fat was removed to allow it to pass through, and left intact with an Allen clamp. The abdomen was copiously irrigated with saline solution. When hemostasis was deemed adequate, Seprafilm was inserted. The peritoneum and posterior sheath were closed with a running 2-0 Vicryl stitch, and then the anterior sheath was closed with interrupted #1 Dexon stitches after irrigation of the subcutaneous tissue. Once this was completed, the subcutaneous tissue was re-irrigated. Skin clips were applied, and then the colostomy was matured by excising the staple row, and suturing the full-thickness to the skin to the full-thickness of the bowel circumferentially with 3-0 chromic catgut stitches. It was completely viable and digitalized and completely patent.
Specimen: Sigmoid, rectum and anus

Thank you.


Mayra Luciano, BS, BSN, RN
Clinical Dcoumentation Improvement Specialist
Brookhaven Memorial Hospital Medical Center
101 Hospital Road
Patchogue, NY 11772
631 438 5268
mluciano@bmhmc.org


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Comments

  • edited March 2016
    No, In ICD-10-PCS, the root operation "Bypass," is defined as altering the route of passage of the contents of a tubular body part. Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part.

    sb

  • edited March 2016
    Are you questioning if you need a query to for the part of the colon used for the colostomy?
    If so, I believe you can use sigmoid for the colostomy. Coding Clinic had info on this in 4th Qtr 2015. I have pasted the one regarding colostomy and APR below. A total of 4 codes are required.
    Question:

    The above patient also had colostomy creation at the same time that the lower anterior resection of the rectum was performed. Should the colostomy be coded?

    Answer:

    Yes, creation of the colostomy should be separately coded. In this case the sigmoid colon was bypassed to skin, and is appropriately coded to the root operation "Bypass." Assign the ICD-10-PCS code as follows:

    0D1N0Z4

    Bypass sigmoid colon to cutaneous, open approach


    In ICD-10-PCS, the root operation "Bypass," is defined as altering the route of passage of the contents of a tubular body part. Bypass is coded when the objective of the procedure is to reroute the contents of a tubular body part. The range of "Bypass" procedures includes normal routes such as those made in coronary artery bypass procedures, and abnormal routes such as those made in colostomy formation procedures.
    ***********************************************************************************************************************************
    Abdominoperineal resection

    Coding Clinic, Fourth Quarter ICD-10 2014 Pages: 40-41 Effective with discharges: December 31, 2014
    Related Information
    Question:
    A 57-year-old male with low rectal cancer presents for abdominoperineal resection (APR) of the rectum with reconstruction to follow. A cylindrical APR was performed, along with excision of the sigmoid colon and resection of the anus. Should the excision of the sigmoid colon and resection of the anus be reported separately?

    Answer:
    Yes, the resections of the rectum and anus as well as the excision of the sigmoid colon are separately coded. To capture the entire surgery, all three codes are required. Assign the following ICD-10-PCS codes:

    0DTP0ZZ

    Resection of rectum, open approach





    0DTQ0ZZ

    Resection of anus, open approach





    0DBN0ZZ

    Excision of sigmoid colon, open approach


    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org

  • edited March 2016
    Yes, we are questioning if we need to query to code the part of the colon used for the colostomy?
    Thank you so much for your input!


    Mayra Luciano, BS, BSN, RN
    Clinical Dcoumentation Improvement Specialist
    Brookhaven Memorial Hospital Medical Center
    101 Hospital Road
    Patchogue, NY 11772
    631 438 5268
    mluciano@bmhmc.org


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