Coder's Cranium / General

Learn the Keys to Properly Coding MACE, Mitrofanoff, and More

You’ll be able to report anastomosis with some procedures and not others.

If your urologist sees pediatric patients you may occasionally run across some procedures that you’re not used to coding.  When your urologist performs a Malone antegrade colonic enema (MACE), a Mitrofanoff procedure, or a Monti procedure, you might be left scratching your head over the proper code choice.  Follow this expert guidance to ensure you’re reporting the proper codes for every pediatric surgery your urologist performs.

Differentiate MACE and Mitrofanoff Before Coding

The MACE and Mitrofanoff procedures are similar, as both are used mainly in pediatric patients and involve similar anatomy, which makes coding for them a challenge.

MACE: For the MACE procedure, the physician uses the appendix or other small section of bowel to create an opening attached to the skin (a cutaneous stoma) to be used to irrigate antegrade with a catheter fecal matter from the colon.  “The MACE is generally a pediatric procedure used on children, but could also be used on adults, with chronic constipation or fecal incontinence.  Usually these diagnoses are found in children who are born with spina bifida or other neurological abnormalities,” explains Janell Glascock, CCS, CPMA, certified coding specialist for the Indiana University Health Physicians, Urology Department in Indianapolis.

For the MACE procedure you will first report 50845 (Cutaneous appendico-vesicostomy), says Christy Shanley, CPC, billing manager for the University of California, Irvine Department of Urology. Append modifier 52 (Reduced services) because the urologist is doing part of an appendicovesicostomy (isolating the appendix but doesn’t remove it from the large bowel).  Then, report 44680-51 (Intestinal plication [separate procedure]; multiple procedures) for the plication of the bowel, Shanley says.

Mitrofanoff: “The Mitrofanoff [procedure] can also use the appendix, or other small bowel if the appendix is not available, and attaches...

Comments Off on Learn the Keys to Properly Coding MACE, Mitrofanoff, and More
May 20, 2011
Hot Coding Topics

Diagnosis Coding: G Codes Are Your Key To Coding Correct High Risk Colonoscopy

Get your hemorrhoid report right and stress-free in a snap. We’ll tell you the difference between internal and external hemorrhoids, but you can learn more from this sample physician’s report:

PREPROCEDURE DIAGNOSIS: History of colon polyps and partial colon resection, right colon.

POSTPROCEDURE DIAGNOSES:

  1. Normal operative site.
  2. Mild diverticulosis of the sigmoid colon.
  3. Internal hemorrhoids.

PROCEDURE: Total colonoscopy.

PROCEDURE IN DETAIL: The 60-year-old patient presents to the office to be evaluated for the preprocedure diagnosis. The patient also apparently had an x-ray done at the hospital and it showed a dark spot, and because of this, a colonoscopy was felt to be needed. She was prepped the night before and on the morning of the test with oral Fleet’s, brought to the second floor and sedated with a total of 50 mg of Demerol and 3.75 mg of Versed IV push. Digital rectal exam was done, unremarkable. At that point, the Pentax video colonoscope was inserted. The rectal vault appeared normal. The sigmoid showed diverticula throughout, mild to moderate in nature. The scope was then passed through the descending and transverse colon over to the hepatic flexure area and then the anastomosis site was visualized. The scope was passed a short distance up the ileum, which appeared normal. The scope was then withdrawn through the transverse, descending, sigmoid, and rectal vault area. The scope was then retroflexed, and anal verge visualized showed some internal hemorrhoids.

RECOMMENDATIONS: Repeat colonoscopy in three years.

Let Location Guide You

You can easily identify external hemorrhoids (455.3-455.5) because of its place of appearance. This type of hemorrhoid has a fleshy growth and occurs around the anus — specifically, outside the anal verge which is at the distal end of the anal canal. On the other hand, internal hemorrhoids (455.0-455.2) occur inside the...

Comments Off on Diagnosis Coding: G Codes Are Your Key To Coding Correct High Risk Colonoscopy
March 7, 2011
Coding Challenge / modifier 22

Is 44145 the CPT code for Lap-to-Open Colectomy?

Question: What codes would you use for lower anterior resection with anal anastomosis and divered ileostomy with mobilization of splenic flexure, which was converted to an open procedure? Answer: You’ll report the open procedure codes for this case. ...

Comments Off on Is 44145 the CPT code for Lap-to-Open Colectomy?
October 15, 2010
Coding Challenge / modifier 22

Surgical Coding: Capture Extra Work for Choledochal Cyst

Discover these subsequent reconstruction codes. Question: The surgeon treated a patient with a large choledochal cyst. The procedure involved an open cholecystectomy with en bloc excision of extrahepatic bile ducts (roux-en-Y reconstruction) with hepaticojejunostomy. What are the correct CPT and ICD-9 codes? Answer: The correct ICD-9 code will depend on whether the patient has an acquired [...] Related articles:

  1. Quick Start Guide to Benign Ovarian Cyst Dx CodingTip: An endometrial cyst is also known as a chocolate...
  2. Coding Ovarian Cyst Removal: Are You Making These 4 Mistakes?Here’s how you could potentially add $184 to your bottom...
  3. Surgical Coding: Scar Revision on Previous Mastectomy SiteTip: Find mastectomy scar revision in wound repair Question: Our...

Comments Off on Surgical Coding: Capture Extra Work for Choledochal Cyst
February 9, 2010