Forum - Questions & Answers

Jan 10th, 2022 - KHill 1 

Parastomal Hernia Repair w/Colostomy Closure

Hi All, I need help with a CPT code. Can anyone tell me if the repair of a parastomal hernia is included in the closure of a colostomy/Hartman's pouch? I have looked everywhere I can think, but cannot find anything either way. The surgeon who performed the repair wants to use some codes I don't think are correct. These are the codes the surgeon want to use: Takedown of colostomy with low pelvic anastomosis. (CPT 44626) - I agree with this code for the closure of the colostomy. Repair of parastomal hernia. (CPT 44346 or 49560) - I don't think either of these codes is correct. I am coding for the hospital, not the physician and this is an Inpatient account. Any help would be greatly appreciated! Thanks!

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Jan 11th, 2022 - ChrisW   234  1 

re: Parastomal Hernia Repair w/Colostomy Closure

If it is an incidental hernia, it is not coded separately, for example, if it is performed at the sight of the incision for an abdominal procedure. I would suggest reviewing the NCCI edits, this will let you know which codes may or may not be reported together.  You may find help in this situation. With limited information, I can only direct you to suggestions to consider.  Be sure you run your codes through the NCCI editor. 
 
Ref NCCI coding manual: CHAPTER VI, SURGERY: DIGESTIVE SYSTEM
 
“4. If a hernia repair is performed at the site of an incision for an open or laparoscopic abdominal procedure, the hernia repair (e.g., CPT codes 49560-49566, 49652-49657) is not separately reportable. The hernia repair is separately reportable if it is performed at a site other than the incision and is medically reasonable and necessary. An incidental hernia repair shall not be reported separately.” 
 
“12. An enterostomy closure HCPCS/CPT code shall not be reported with a code for creation or revision of a colostomy. Closure of an enterostomy is mutually exclusive with the creation or revision of the colostomy.”
With limited information, take a look at the following for your consideration.  Hopefully, someone with additional information can give us some advice.  Also, consider if the procedures below are open or laparoscopic.

44346  Revision of colostomy; with repair of paracolostomy hernia (separate procedure)
50727 - Revision of urinary-cutaneous anastomosis (any type urostomy)
44626 Closure of enterostomy, large or small intestine; with resection and colorectal anastomosis (eg, closure of Hartmann type procedure)

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Jan 11th, 2022 - KHill 1 

re: Parastomal Hernia Repair w/Colostomy Closure

Thank you for your reply.  I need all the information I can find when coding our surgeons' procedures.  They insist on using the CPT codes they code and will go to the Executive Team Lead over my department and say I am not coding correctly and losing money, so I need this information to back up my coding.  Thank you again.  I appreciate your help.

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