Laureen: Q: (Hernia Repair) My surgeon did an open parastomal hernia repair with mesh with ileostomy stomal revision. I see the code 44346 for “revision of colostomy with repair of paracolostomy hernia.” Can I bill 44312 with the above hernia codes for this? HELP!
Thank you, Nichole.
Laureen: OK, here’s my little research sheet I worked up. What we’d like to do with these answer sheets is restate the question again that was on the slide and then in purple give the answer. We really try and give you our thought process on how we went into the research and any websites we’ve found and the codes and pretty much all the details that you need. And we want to teach you how to fish, not so much as to just give you the answer. So, I’ll try and reproduce how I came up with this and hopefully that will help you in research that you’ll do on your own.
A: First of all, I wanted to get my head wrapped around what a parastomal hernia was. I had an idea, “para” I know means “around,” “stoma” is, like, if you think of colostomy, that hole is the stoma; or tracheostomy, that hole is called the “stoma.” So, I knew that they were doing something, that artificial opening. And that hernia some sort of protrusion that shouldn’t be there.
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From this website uptodate.com, I found this definition: Parastomal hernia is the most frequent complication following the construction of a colostomy or an ileostomy occurring in up to 50 percent of patients. A parastomal hernia is a type of incisional hernia that allows protrusion of abdominal contents through the abdominal wall defect created during ostomy formation. It should be recognized that, unlike a hernia development in a surgical incision for which the fundamental problem is healing between tissues that have been approximated, ostomy creation introduces an abdominal wall defect, the trephine, for which no healing is expected. A parastomal hernia forms as the trephine is continually stretched by the forces tangential to its circumference. That’s the official definition.
Just restating the procedures that Nichole put, the first thing I saw was an open parastomal hernia repair with mesh, and I agree with her that it’s the 49560. I copied and pasted this from my encoder that I love, Find-A-Code, and it says: repair of initial incisional or ventral hernia, reducible and with the add-on mesh code, 49568. By the way, this add-on mesh code, there’s tons of hernia repair codes, only the incisional or ventral hernia codes are allowed to have this add-on code. If you use mesh for any of the others, its bundled in. So, this one, she’s correct for these two codes. I’m with her on this so far.
Then, the second thing that she mentioned is ileostomy stomal revision. So, for this one, I would code either 44346 she mentioned or 44312 but not both. I’m inclined to go with the former and I’ll explain why. But first I just want to go back to my statement here, if I had the full op report, I might change what I’m suggesting. But you have to understand in the context in these quick little questions, I get like more of a procedure statement, so I don’t really know if this ileostomy is where they’re doing the revision of the colostomy; so that’s why my answer might change a little bit.
So, let’s take a look at what I found in doing my research on SuperCoder, another favorite site of mine. You do have to have a membership as a SuperCoder.com user, same with Find-A-Code. Both of them have articles. SuperCoder uses their own in-house writing staff through like the Coding Institute and Find-A-Code uses the DecisionHealth writers. Because of the nature of what we do on these webinars we have subscriptions to both.
SuperCoder had a good one here. It said: “Repair of a parastomal hernia can be reported with one of the incisional hernia repair codes…” – which we already with the 49560. See that up here? – “…if the stoma itself requires no revision.” In this case it did, so now it says “If the stoma is revised along with the hernia repair, report code 44346 Revision of colostomy; with repair of paracolostomy hernia.”
So, that’s what this code is kind of designed for, that if there’s a repair, which we just read is a very common occurrence that is the coding combination you would typically do. So, the 49560 with the mesh code, the 49568, and the 44346 for that stoma repair. Here’s the link that if you’re a SuperCoder user, you can go and look that up.
So, my final conclusion is, I would go with that 44346 if it’s related to the fix in #1 – meaning that it’s the same stoma, which is more likely. If #1 is not of the ileum then I’d go with 44312 for the ileostomy stomal revision.
Here are the codes that I copied and pasted from Find-A-Code. The only one that I would not code is this first one, and I would code this one instead, revision of the colostomy with repair of the paracolostomy hernia. And just to give you an idea of why I love Find-A-Code is they have these great plain English descriptions that come from…
Let me show you how that works just so we can teach you how to fish here… With Find-A-Code, I’m going to pop in this code, 44346, and this brings me up, what you would see in the CPT manual right here and then the plain English description. It really paints a picture of exactly what’s happening and that really helps us as coders if we get what’s going on, it makes us be more accurate coders.
“Revision may be necessary if the stoma becomes constricted or obstructed, the intestine prolapses through the stoma (so it pops out through it), and the intestine retracts causing the stoma to sink below the level of the skin. The intestine detaches from the skin, necrosis occurs or the patient develops a parastomal hernia.” So, that’s definitely painting the picture.
Another thing that they have is images, so here’s a nice graphic of what’s going on. So, minor surgical revision is made to the opening – so here we can see the stoma that is malfunctioning, if you will. So, what they do is they close the former colostomy site; it’s where the old opening was, and they open up a new one and just poke into another area, in this case the colon. So you can see here how that’s from DecisionHealth. So, we love Find-A-Code, we love SuperCoder. I think for everyday coding, I really like Find-A-Code better. For some of the articles, I like SuperCoder better; so it depends on your needs.
We’re thinking of coming up with a CCO version of Find-A-Code, if that would interest, put a “3” in the chat and that will help us know if you’d be interested in that.
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