Tag: Articles

Oh the screening colonoscopy…I can think of few procedures in surgery that seem so simple and yet create so many questions about proper coding and billing.

One thing I see quite frequently is a colonoscopy documented as a screening but also listing multiple lower GI symptoms like RLQ abdominal pain and rectal bleeding. Many coders have asked me how to code a colonoscopy in this situation – as a screening per what the GI physician listed or as a diagnostic colonoscopy due to symptoms?

The answer to this question can be found in how the ICD-10-CM manual defines a screening. In the ICD-10-CM guidelines, Chapter 21.c.5, screening is defined as follows:

Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease (e.g., screening mammogram). The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening. In these cases, the sign or symptom is used to explain the reason for the test.

Based on this guideline, when both screening and lower GI symptoms are documented as indications for the colonoscopy, the case should be coded as a diagnostic colonoscopy. The colonoscopy is not truly a screening if the patient has known lower GI symptoms that could indicate lower GI disease. To truly be considered a screening, the patient should be “seemingly well” (i.e., without known symptoms or disease of the colon).

Q. Can you explain the difference between CPT codes 44140 and 44160? Both codes represent a partial colectomy, and I am unclear on what work must be performed after the colectomy to choose between the two codes.

A. These two codes often generate confusion for surgical coders. The confusion usually stems from uncertainty about what the term “ileocolostomy” which appears in the description of CPT 44160 means and what part of the bowel is removed in each procedure. Before we break down the definitions of both codes, if you are a visual learner and want a refresher on the anatomy of the colon, check out this image: Segments of the Colon Explained

• CPT 44140 includes a partial colectomy with an anastomosis (reconnection) of two ends of remaining colon in the body. The anastomosis created during this procedure is a “colo-colonic” (or colon to colon anastomosis). For example, if a laparotomy incision is made and part of the ascending colon and the transverse colon are removed followed by an anastomosis between the remaining ends of the ascending and transverse colon, CPT 44140 should be coded. The same would be true for an open approach with partial removal of any part of the colon followed by anastomosis of the remaining two ends of the colon (e.g., removal of the descending colon with anastomosis between the sigmoid and the transverse colon, removal of the transverse colon and ascending colon with anastomosis of the cecum and the descending colon, etc.).
• CPT 44160 on the other hand represents excision of part of the colon and excision of the terminal ileum (the end of the last segment of the small intestine) followed by an ileocolostomy. The term ileocolostomy is often confusing because, in other colectomy codes where we see a term ending in “-ostomy” (colostomy, ileostomy, etc.), the “ostomy” refers to bringing the remaining end of the colon up to an opening created in the abdominal wall. A bag is then attached and feces leave the body through that artificial opening. At its most basic level, though, the suffix “-ostomy” simply means to “create an opening” or to “create a new connection.” So the term ileocolostomy means “to create a new connection between the ileum and the colon.” When we look at the description of CPT 44160 with this new understanding, the procedure represented by this code becomes clearer. To code CPT 44160, the documentation must support 1) removal of part of the colon, 2) removal of the terminal ileum, and 3) an anastomosis (new connection) between the remaining ileum and the remaining colon. For example, if a laparotomy incision is made, the terminal ileum and cecum are removed, and the ascending colon and the remaining ileum are anastomosed, CPT 44160 should be coded. Again this code is appropriate when any part of the colon and terminal ileum are removed through an open approach and an ileocolonic anastomosis (aka an ileocolostomy) is created (e.g., the terminal ileum, cecum, ascending, and part of the transverse colon are all removed and the remaining transverse colon and ileum are anastomosed).

For those of you coding laparoscopic colectomies, the same explanation provided above for CPT 44140 and 44160 also applies to CPT codes 44204 and 44205 in the laparoscopic world. CPT 44204 is for a laparoscopic approach with removal of part of the colon and a colocolonic anastomosis while CPT 44205 is for a laparoscopic approach with removal of part of the colon and the terminal ileum followed by an ileocolostomy.

Understanding the terminology in the code descriptions as well as the anatomy of the colon and the small intestine are keys to coding surgeries these surgeries accurately.