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...