JMRWife wrote:Another question; does the surgery have 3 different names because it's 3 distinct procedures?
Laproscopic sigmoid (colectomy)?
If so, that's a lotta surgery!
As I said I'm seeing my surgeon tomorrow but I cannot wait to find at least some ballpark answers to my questions. I know that you guys aren't doctors but I'm very anxious. This is not at all what is an all my surgeons notes on my portal. Consistently he said sigmoid colectomy.
I understand your concern. I think the best way to approach this is to look at the defined Current Procedural Terminology (CPT) billing codes for various colorectal procedures. A list of some of the 2021 CPT codes is given in the document below :https://asiapac.medtronic.com/content/dam/covidien/library/us/en/services-support/reimbursement/reimbursement-coding-guide-medicare-colorectal-surgery.pdf
What I would suggest is to look at this in two steps. First, what procedure(s) did they use on April 28 when they did the «diverting colostomy»? Then, once you have figured out which procedure(s) they probably used 5 months ago, you can hypothesize which procedure(s) they have left to do this time around.
Since I am not a doctor, I can only speculate on what the situation might be, but I will share my thoughts and you can go from there to speculate on what might be the actual situation.
- April 28th procedure(s). You say that they did a «diverting colostomy» to handle an obstruction in the proximal sigmoid colon at 30 cm from the anal verge but you didn’t say what kind of surgery was involved, either laparoscopic or open. So there are several scenarios possible for what they did on April 28.
Thus, after the April 28 operation you were left with a diverting colostomy for sure, but also a sigmoid colon with a tumor still in place, so the procedures to be done on October 4th would depend on what is still left to do according to the surgeon’s current, updated judgment.
- A simple diverting colostomy done by laparoscopy, leaving the tumor in place, clamped off, and isolated. This would probably be coded as :
443188 «Laparoscopy, surgical, colostomy or skin level cecostomy»
- A simple diverting colostomy done by open surgery, leaving the tumor in place, clamped off, and isolated. This would probably be coded as :
44320 «Colostomy or skin level cecostomy»
- October 4th procedure(s). There are a number of possible scenarios, depending on what was done on April 28 and what the surgeon thinks should be done at this time.
In particular, the question is whether he is planning to do a surgery to remove only the segment of sigmoid colon containing the tumor and then re-connect the remaining part of the upper sigmoid colon to the upper part of the rectum while at the same time removing the diverting colostomy, or whether he is planning to do a more extensive surgery that involves removal of both the sigmoid colon and all or part of the rectum while leaving the diverting colostomy in place.
In one scenario, the surgery would involve a sigmoid colectomy, an anastomosis procedure for re-connection, and a colostomy takedown procedure. After this set of procedures you would then be left without a colostomy but would be expected to have normal bowel function after a short period of recovery from surgery. What would be removed permanently would be the segment of sigmoid colon containing the tumor along with good surgical margins, and the diverting colostomy connection. (According to your September 10th post, this is the option that he preferred at that time.)
In a second, more drastic, scenario, the surgery would leave the current diverting colostomy in place (i.e., no colostomy reversal), but remove everything from the sigmoid colon down through the rectum. There would be no re-connect and no anastomosis procedure, since the plan would be to leave the diverting colostomy in place from now on. This type of procedure is normally called an abdominal perineal resection (APR), not low anterior resection (LAR).
These are not the only possible scenarios. There are other scenarios, depending on what the surgeon feels should be removed at this time.
The CPT codes for these procedures would be the ones involving terms such as «partial colectomy», and possibly «proctectomy», «anastomosis», «mobilization (take down)», etc.
What I would suggest is for you to to go through the list of CPT procedures before Thursday and familiarize yourself with the basic terminology so that you can carry on an informed conversation with the surgeon.
Whenever a surgeon does an operation, he will eventually have to create a special surgery report for billing and insurance purposes with the report containing all of the CPT codes for the procedures that he ended up performing during the operation.
Some of the procedure codes that might be relevant for your October 4th surgery are :
44143 Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)
44206 Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure)
44213 Laparoscopy, surgical, mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in addition to primary procedure)
45110 Proctectomy; complete, combined abdominoperineal, with colostomy
These are not the only ones possible. You need to look through the whole list of CPT codes and try to understand which of the available procedures might be used to cover the
Laproscopic sigmoid (colectomy)?
procedures mentioned in your post.