Ask the Expert

This month’s selection:

I am hoping you can assist me with procedure code assignment for an ileostomy revision due to a small bowel obstruction due to an ileostomy stricture. As per the operative report, the procedure was performed as follows: “A circular incision was made with a 15 blade around the old ostomy site for about 1 inch, and cautery was used for the subcutaneous tissue. This was taken down for about an inch and brought across, dividing the stoma, bringing us to the mucosa that was available. This mucosa was then split open and sewn to the side of the dermis with multiple interrupted sutures holding the ostomy open for about an inch.” The pathology report indicated a wedge of coarsely wrinkled skin. As no bowel was removed, bowel resection was not appropriate. It was not a stoma closure, so abdominal wall repair does not seem correct either, as repair denotes restoring a body part to its normal anatomic structure and function.

Dawn Zimmerman, RN, CCS

Response:

Based on documentation provided, no specific code can be assigned. Suggest a query be written to clarify the level of the stricture: skin level, fascia level, and intraluminal level. Also, clarification is needed to determine whether the stricture was released. This will help to determine the appropriate root operation. The root operation repair should only be used when the method to accomplish the repair is not one of the other root operations.

Until the query is answered a specific code cannot be assigned. Below are several code options available.

0JQ80ZZ, Repair Abdomen Subcutaneous Tissue and Fascia, Open Approach

0WQF0ZZ, Repair Abdominal Wall, Open Approach

0JN80ZZ, Release Abdomen Subcutaneous Tissue and Fascia, Open Approach

— Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS, is director of coding quality and professional development at TrustHCS and an AHIMA ICD-10-CM/PCS trainer certificate holder.