 OPENING UP ABOUT
OSTOMIES……………... 1


OSTOMY CODING
CONTINUED……… ....... 2
CODING REFERENCE… .. 2
Risk Adjustment and
Coding Academy
Coding | Risk Adjustment | Documentation | Training

HEALTHCARE LAW
SAVED………………2
Coding
Insight
Vol. 7 Oct. 2012
Opening up about Ostomies
Introduction
Definition of an Ostomy
An ostomy is a surgically created opening
connecting an internal organ to the outside
of the body, creating a stoma. These types
of surgical procedures end in the suffix –
ostomy and begin with a prefix that
represents the organ or area being
operated on. Stomata are generally found
in procedures involving the gastrointestinal
tract (GIT). The GIT begins at the mouth or
oral cavity and continues to the anus. There
are approximately 750,000 people in
America with ostomies.
Coding Categories for Ostomies
Status only, without need for care
Per ICD- 9 Coding Guidelines, “Status codes
indicate that a patient is a carrier of a
disease, has the sequelae or residual of a
past disease or condition, or has another
factor influencing a person’s health status.
This includes such things as the presence of
prosthetic or mechanical devices resulting
from past treatment and its outcome. A
status code is different from a history code.
The history code indicates that the patient
no longer has the condition.” (2012 ICD-9CM) Status codes should only be used as a
secondary diagnosis.
Do not assign the status code if the
diagnosis code includes the information
provided by the status code. For example,
code V44.0 (tracheostomy status) should
not be used with code 519.09 (other
tracheostomy
complications).
The
complication code specifies that the
patient has a tracheostomy. The status
code is unnecessary because it does not
provide any additional information.
A mechanical complication is due to a
malfunctioning device. Examples of other
specified complications include fistula,
hernia, and prolapse,
Types of Ostomies
Attention to artificial opening
The “attention to artificial opening” codes
are included in aftercare visit codes. Per
ICD-9 Coding Guidelines, “Aftercare visit
codes cover situations when the initial
treatment of a disease or injury has been
performed and the patient requires
continued care during the healing or
recovery phase, or for the long-term
consequences of the disease” (2012 ICD-9
CM). Some examples of services
considered as “attention to” are:
adjustment or repositioning, closures,
reforming, removal or replacement, and
cleansing.
Do not assign a status code when the
aftercare code specifies the type of status
code. For example, do not code V55.0
(attention to tracheostomy) with V44.0
(tracheostomy status).
If no care is
provided to the ostomy, use the status
only code.
Complications
Complications of ostomies may include
infections, mechanical or functional
problems,
and
other
specified
complications. If a complication is due to
an infection, assign a code to specify the
type of infection if documented (such as
an abscess or septicemia) in addition to a
code for the identified organism.
Tracheostomy
A tracheostomy is the surgical creation of
an opening into the trachea (windpipe)
through the neck. This procedure is
generally performed to allow the passage
of air when there is an obstruction or
impairment.
Gastrostomy
A gastrostomy is a surgical procedure for
inserting a gastric tube (G-tube) through
the abdominal wall into the stomach. The
G-tube may be used for feeding or
drainage, but it is generally used for
feeding. An example is a percutaneous
endoscopic gastrostomy tube (PEG tube).
Ileostomy
An ileostomy is the surgical creation of an
artificial excretory by connecting the ileum
to the opening in the abdominal wall
forming a stoma. Once the surgery is
complete, the patient wears a disposable
bag to collect the semi liquid fecal matter.
Colostomy
A colostomy is a surgical procedure in
which a small portion of the colon is
brought to the surface of the abdominal
wall in order for stool to be eliminated.
Ostomy coding cont…
Test Your Knowledge
1. Patient presents with complaint that his
PEG tube has fallen out. Stoma is still
intact, but the tube is dislodged. The tube
was replaced and patient was discharged.
What diagnosis code would you use for
dislodged PEG tube?
Coding Reference
V44.0- Status of
V55.0- Attention to
519.0x -Complication
Tracheostomy
V44.1- Status of
V55.1- Attention to
536.4x- Complication
Gastrostomy
V44.2- Status of
V55.2- Attention to
569.60- Complication
Ileostomy
V44.3- Status of
V55.3- Attention to
569.6x- Complication
Colostomy
V44.4- Status of
V55.4- Attention to
569.60- Complication
Status of other
art. opening of
GIT
________________
An ileostomy and colostomy may be
permanent or temporary. Additionally, an
ileostomy/ colostomy pouch can either be
open-ended, requiring a closing device, or
closed and sealed at the bottom.
Other artificial openings of gastrointestinal
tract
A jujunostomy is an example of an “other
artificial opening of the gastrointestinal
tract” as defined by ICD-9. A jejunostomy is
the surgical formation of an opening
through the abdominal wall into the
jejunum (the second part of the small
intestine) in order to insert a jejunostomy
feeding tube (J-tube). This tube is used for
enteral feeding when illness or injury makes
it necessary to bypass the upper
gastrointestinal tract.
2. Patient is being evaluated for flu
symptoms. Noted to have a colostomy bag
in the exam. What diagnosis code should
you use for status of the colostomy?
___________________
3. After an evaluation, the physician notes
that there is protrusion of the ileum
through the stoma. Thus, diagnosing the
patient with stomal prolapsed. What
diagnosis code would you use?
___________________
Test Your Knowledge Answers:
1. V55.1, Attention to Gastrostomy
2. V44.3, Colostomy status
3. 569.69, Other complications of ileostomy
On the Horizon…
HEALTH CARE LAW SAVED AN ESTIMATED $2.1 BILLION FOR CONSUMERS
The health care law – the Affordable Care Act – has saved consumers an estimated $2.1
billion on health insurance premiums according to a new report released today by the
Department of Health and Human Services. For the first time ever, new rate review rules in
the health care law prevent insurance companies in all states from raising rates with no
accountability or transparency.
For more information, go to:
http://www.cms.gov/apps/media/press/release.asp?Counter=4446&intNumPerPage=10&check
Date=&checkKey=&srchType=1&numDays=3500&sr
References:
Official ICD-9-CM Coding Guidelines 2012
Following online resources:
http://www.ostomy.org/ostomy_info/whatis.shtml
http://medical-dictionary.thefreedictionary.com
Y0071_12_16383_I_11/29/2012