Ileostomy closure icd 10

1. ICD-10-CM Codes
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2. Z00-Z99 Factors influencing health status and contact with health services
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3. Z40-Z53 Encounters for other specific health care
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4. Z43- Encounter for attention to artificial openings
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5. 2022 ICD-10-CM Diagnosis Code Z43.2

Encounter for attention to ileostomy

2016201720182019202020212022Billable/Specific CodePOA Exempt

• Z43.2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
• The 2022 edition of ICD-10-CM Z43.2 became effective on October 1, 2021.
• This is the American ICD-10-CM version of Z43.2 - other international versions of ICD-10 Z43.2 may differ.

• Attention to ileostomy (artificial opening to intestine)
• Attention to ileostomy done

• Z43.2 is considered exempt from POA reporting.

• 393 Other digestive system diagnoses with mcc
• 394 Other digestive system diagnoses with cc
• 395 Other digestive system diagnoses without cc/mcc

Convert Z43.2 to ICD-9-CM

• 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)
• 2017 (effective 10/1/2016): No change
• 2018 (effective 10/1/2017): No change
• 2019 (effective 10/1/2018): No change
• 2020 (effective 10/1/2019): No change
• 2021 (effective 10/1/2020): No change
• 2022 (effective 10/1/2021): No change

• Admission (for) - see also Encounter (for)
  • attention to artificial opening (of) Z43.9
    ICD-10-CM Diagnosis Code Z43.9

    Encounter for attention to unspecified artificial opening

    2016201720182019202020212022Billable/Specific CodePOA Exempt
• Attention (to)
  • artificial
    • opening (of) Z43.9
      ICD-10-CM Diagnosis Code Z43.9

      Encounter for attention to unspecified artificial opening

      2016201720182019202020212022Billable/Specific CodePOA Exempt
      • digestive tract NECZ43.4
        ICD-10-CM Diagnosis Code Z43.4

        Encounter for attention to other artificial openings of digestive tract

        2016201720182019202020212022Billable/Specific CodePOA Exempt
  • ileostomy Z43.2
• Ileostomy
• Removal (from) (of)

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

CDI Strategies, May 12, 2016

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Q: When I try to code ileostomy take down of the small bowel resection and end-to-end anastomosis I get to code 0DBB4ZZ. Is this not a repair of the ileum and coded to 0DQB3ZZ? Coding Clinic notes the prior code not the latter, but repair means restore to previous function.

A: Coding Clinic states:

“The ileostomy takedown is coded as ‘Excision’ because part of the ileum is removed, and the anastomosis is considered inherent to the surgery and not coded separately. The ICD-10-PCS Official Guidelines for Coding and Reporting state ‘Procedural steps necessary to reach the operative site and close the operative site, including anastomosis of a tubular body part, are also not coded separately.’ Assign the following ICD-10-PCS codes: 0DBB0ZZ Excision of ileum, open approach (for the ileostomy takedown); 0WQF0ZZ Repair abdominal wall, open approach (for parastomal hernia repair and stoma closure.)

The definition of repair is “repairing to the extent possible, a body part to its normal anatomic structure and function.” I agree that the takedown does seem to fit the definition of a repair but, per the Coding Clinic it is coded to the root operation of excision.

The ICD-10 code set was designed to assist with standardization of healthcare data for use with reimbursement and statistical analysis which can be applied to quality measures, research, and demographic analysis. If we each choose to use these codes as we interpret them versus how the Cooperating Parties direct us to, the data would be useless.

There are times that the coding instructions do not appear to make sense or clinically support the situation but we are required by law to apply these rules consistently. We must do our best to follow the instructions as provided and the instruction regarding how to code a colostomy takedown within the Coding Clinic is very clear—as being an excision versus a repair.

We can, however, challenge this logic by submitting a Coding Clinic question to its editorial advisory board for further clarification. Questions can be submitted at http://www.codingclinicadvisor.com/.  You receive a reply usually within a few weeks.

And, Coding Clinic advice does change over time, as new concerns are brought to life. The most recent instruction will “trump” any previous advice and any conflicting advice given in preceding years will become null. But until changes are provided we must follow the instruction given. This can be frustrating but we must work to support the integrity of the code set.

Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, and CDI Education Director at HCPro in Danvers, Massachusetts, answered this question, a portion of which is included in the May/June edition of the CDI Journal. Contact her at [email protected] For information regarding CDI Boot Camps visit www.hcprobootcamps.com/courses/10040/overview. 

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Closure of a temporary ileostomy

Publication Date: March 2015

ICD 10 AM Edition: Seventh edition

Retired Date: 30/6/2017

Query Number: 2759

At a recent external coding audit, we were advised to include 30566-00 [895] Resection of small intestine with anastomosis when we code: "Closure of Ileostomy", where the operation report says a small bowel resection was performed. We had assumed that a portion of the ileum would be resected to enable the two segments of bowel to be rejoined.

From searching the internet, it seems that resecting a portion of the bowel is inherent in the ileostomy reversal procedure. Below are two sample operation reports for your reference:

OPERATION ONE: Closure of loop ileostomy with small bowel resection and ileo-ileal anastomosis, repair of parastomal hernia. PREOPERATIVE NOTE: This woman had had a rectal cancer managed by an ultra low anterior resection with a covering loop ileostomy. A Gastrografin enema and direct inspection of the anastomosis had revealed an intact anastomosis without contrast extravasation. There was no stricturing. OPERATIVE DETAILS: Under general anaesthesia the patient’s abdomen was prepped and draped to expose the stoma. An elliptical incision was made centered on the stoma and then the ileostomy mobilized from the surrounding tissue. In performing the mobilization a large parastomal hernia was encountered. The loop ileostomy was mobilized from the parastomal hernial sac and then omentum and another loop of bowel freed up from the hernial sac. Once sufficient mobility was achieved a small bowel resection was performed to remove the loop ileostomy and at the same time a side-to-side stapled anastomosis created with the GIA-80 stapler. The second firing closed the enterotomy and resected the bowel. The staple lines were reinforced with 3/0 PDS. The anastomosis was returned to the abdominal cavity and then the parastomal hernial sac excised. Further adhesions were then removed from the posterior abdominal wall to allow the hernia to be closed in a primary repair using 1 PDS. Once the fascia had been closed the wound was thoroughly irrigated and then the skin closed with interrupted Prolene sutures.

OPERATION TWO: Closure of loop ileostomy requiring small bowel resection and side-to-side stapled anastomosis. PREOPERATIVE NOTE: This woman had undergone a laparoscopic ultra low anterior resection with a colorectal anastomosis and a covering loop ileostomy. A Gastrografin had revealed an intact and watertight anastomosis and rigid sigmoidoscopy and digital rectal examination revealed a patent anastomosis. OPERATIVE DETAILS: Under general anaesthesia the patient was prepped and draped to expose the entire abdomen. An elliptical incision was made around the stoma and this was then mobilized from the abdominal wall down to the fascia until the peritoneum was entered. Complete circumferential mobilization then occurred allowing delivery of the ileum. The proximal ileum was thickened and mildly distended but appeared healthy. The segment of ileum was then resected and a stapled side-to-side anastomosis created using a GIA-80 blue stapler. All staple lines were reinforced with 3/0 PDS. Some bleeding from the staple line intra-luminally was dealt with by an under-running 3/0 PDS suture prior to a second firing of the stapler which closed the enterotomy and resected the bowel. The dog-ears were then buried and the cross staple line also buried. The anterior staple line was reinforced with 3/0 PDS sutures. At the end of the procedure it was necessary to enlarge the fascial opening to allow the anastomosis to return to the abdominal cavity. This was then closed using 1/0 PDS and 2/0 Prolene used to close the skin with an interrupted vertical mattress suture.
We are now not sure if the Surgeon documents that a small bowel resection has been performed, we can also assign the code for the resection. We find the Intervention Index slightly confusing:
Closure ileostomy (without resection) 30562-01 [899]
- - with restorative proctectomy 32060-00 [934]
- - following Hartmann's procedure 32033-00 [917]
- - temporary (covering) (defunctioning) (loop) 30562-00 [899]

30562-01 has a non-essential modifier (without resection), but when you go down to Closure, temporary ileostomy there is no modifer, so does this mean that it can be with or without resection? We realise that we aren't to use the CMBS item numbers that the Surgeon's apply, but they often seem to not include the extra code 30566-00 [895] even when they specify that a bowel resection was performed in the operation notes.

Can the Committee please clarify what are the correct codes to assign for Closure of a Temporary Ileostomy, where the operation report states that a resection was also performed? Especially if the clinician can't be sought to clarify, as working in a private hospital makes this difficult.


Search Details:
http://www.hcpro.com/HIM-245886-3288/read-colostomy-ileostomy-documention
http://www.cditalk.com/content/218-colonic-concepts Interventions Index

Response

This query was originally published in the 2012-13 June Database as follows:

Clinical advice obtained by VICC agrees with the enquirer's research in that bowel resection can be inherent in a closure of a temporary ileostomy, however the bowel resection is not always required and therefore not always performed.

VICC considers that when bowel resection or bowel excision is documented with closure of a temporary ileostomy, a code can be assigned for the procedure.

Following publication of ACCD Coding Rules on 15 September 2014, the VICC response is superseded by following advice titled Closure of ileostomy with resection:

Q:
Is a separate code required for resection/excision of bowel with 30562-01 [899] Closure of ileostomy with restoration of bowel continuity, without resection as without resection is a nonessential modifier in the index?

A:

30562-01 [899] Closure of ileostomy with restoration of bowel continuity, without resection includes resection of small sections (freshening) (trimming) from the end of the stoma (exteriorised bowel/doughnuts) and distal intestine prior to anastomosis.

Resection/excision of intestine in excess of this freshening/trimming should be coded in addition to the closure of ileostomy code. This may occur if the diseased section of bowel was not resected prior to creation of the ileostomy or when further pathology is found during the closure procedure.

Where there is no documentation of further pathology of the bowel requiring resection, a separate code for the resection should not be assigned.

Ileostomy status

2016201720182019202020212022Billable/Specific CodePOA Exempt

• Z93.2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
• The 2022 edition of ICD-10-CM Z93.2 became effective on October 1, 2021.
• This is the American ICD-10-CM version of Z93.2 - other international versions of ICD-10 Z93.2 may differ.

• Ileostomy present
• Presence of ileostomy (artificial opening into intestine)

POA Help

"Present On Admission" is defined as present at the time the order for inpatient admission occurs — conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered POA.

• Z93.2 is considered exempt from POA reporting.

• 951 Other factors influencing health status

Convert Z93.2 to ICD-9-CM

• 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-CM)
• 2017 (effective 10/1/2016): No change
• 2018 (effective 10/1/2017): No change
• 2019 (effective 10/1/2018): No change
• 2020 (effective 10/1/2019): No change
• 2021 (effective 10/1/2020): No change
• 2022 (effective 10/1/2021): No change

Diagnosis Index entries containing back-references to Z93.2:

• Artificial
  • opening status (functioning) (without complication) Z93.9

    ICD-10-CM Diagnosis Code Z93.9

    Artificial opening status, unspecified

    2016201720182019202020212022Billable/Specific CodePOA Exempt
• Ileostomy
• Status (post) - see also Presence (of)

ICD-10-CM Codes Adjacent To Z93.2

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

Z93.2 is a billable ICD code used to specify a diagnosis of ileostomy status. A 'billable code' is detailed enough to be used to specify a medical diagnosis.

POA Indicators on CMS form 4010A are as follows:

Parent Code:Z93 - Artificial opening status