Laparoscopic Hemicolectomy

The physician is doing a lap hemicolectomy and makes an additional small incision to "deliver the colon" at which point he divides both ends of the section to be removed, does an anastomosis and returns the bowel to the normal position,  would you code that as an open hemicolectomy?  If so, why is there an option for percutaneous endoscopic approach?


  • This is an interesting question & I am not a PCS expert. the OPEN approach means that the surgeon can directly visualize the surgical bed or site. My first thought is that this would not be open and then with thought- the surgeon is directly  viewing the surgical site by pulling it up through the incision. This might be worthy of a coding clinic question.
  • Interestingly enough when a surgeon does a laparoscopic procedure and uses a hand port, the approach is coded to open. I am not sure the size of the incision the original poster is referring to but possibly something very similar. This coding clinic may muddy the water and another question may need to be posed as Laurie suggested.

    Hand-assisted laparoscopy nephroureterectomy

    ICD-10-CM/PCS Coding Clinic, Third Quarter ICD-10 2014 Page: 16 Effective with discharges: September 15, 2014


    A patient underwent a complete left nephroureterectomy. The kidney and proximal ureter were removed via "hand-assisted" laparoscopy and the distal ureter was removed from the bladder via an incision. What is the appropriate ICD-10-PCS code assignment for a left nephroureterectomy when two planned approaches are used to completely remove the ureter?


    The left kidney and proximal ureter were excised using a "hand port" laparoscopic-assisted approach. At surgery, an 8-cm incision was made to gain access to the distal ureter site. This is considered an open approach. For the left nephroureterectomy assign the following ICD-10-PCS procedure codes:

    Resection of left kidney, open approach
    Resection of left ureter, open approach


  • interesting- perhaps we need to submit to coding clinic.

  • I did submit to Coding Clinic.  Thanks,  
  • Great, let me know how they respond.
  • interesting- perhaps we need to submit to coding clinic.

    I am wondering if the original poster ever heard back from coding clinic on this one.



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