AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2024 Issue 3; Ask the Editor

Secondary Small Bowel Anastomosis with Enterotomy and Repair

A patient was admitted for an emergent exploratory laparotomy. The surgeon performed a resection of the necrotic small bowel with a temporary abdominal closure. Two days postoperatively, the patient underwent a repeat exploratory laparotomy. The small bowel appeared well-perfused and healthy, so it was decided to perform a small bowel anastomosis. During the small bowel anastomosis, a stapler gun was used to close the common enterotomy, but it misfired and resulted in a simple transection of the common enterotomy without stapling any structures. A new stapler gun was used to resect both ends of the anastomosis, which were already starting to look dusky. A new anastomosis was created by cutting off the antimesenteric corners of each fresh staple line and passing a new stapler gun down each limb, firing across the antimesenteric sides. The common enterotomy was closed with simple sutures. The staple line and suture line were imbricated with multiple interrupted sutures. Per ICD-10-PCS guideline B3.1b, procedural steps such as anastomosis of a tubular body part, are not coded separately. In this case, is it appropriate to code the anastomosis of the small bowel? If so, what is the appropriate code assignment for this procedure? ...

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