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Suture repair of the large intestine, known as colorrhaphy, is a surgical procedure aimed at addressing various conditions that result in perforations of the large intestine. This procedure is specifically indicated for cases involving perforated ulcers, diverticula, wounds, injuries, or ruptures, which can lead to significant complications if not treated promptly. During the operation, a surgical incision is made in the abdomen to access the affected segment of the large intestine. The surgeon carefully removes the damaged portion and places it on the operating table for further manipulation. To ensure a safe and effective repair, intestinal contents are expressed from the segment, and the area is clamped above and below the perforation to control the flow of intestinal material. Bleeding control is a critical aspect of the procedure, achieved through the suture ligation of any involved blood vessels. The repair itself involves meticulously closing the opening in the intestine by suturing the mucous membranes first, followed by the serous coat, and finally the muscular wall, ensuring a robust closure to prevent future complications. After the repair, the abdominal cavity is thoroughly cleansed using gauze and irrigation fluid as necessary to minimize the risk of infection. Depending on the clinical scenario, drains may be placed to facilitate fluid management, and the abdominal incision is subsequently closed. In cases where a colostomy is required, the colon is divided above the site of the colorrhaphy. The colostomy procedure involves creating a stoma, which is an opening on the abdominal wall for the passage of intestinal contents. This is accomplished by making a small incision at the planned colostomy site, excising fat down to the anterior rectus fascia, and carefully opening the fascia while protecting the underlying muscle and its blood supply. The rectus fibers are separated using blunt dissection, and the peritoneum is entered to create an opening for the stoma. A peritoneal tunnel may also be established to prevent postoperative obstruction. Finally, the colon is brought through the abdominal wall, everted, and sutured to the skin, completing the colostomy creation. This comprehensive approach ensures that both the repair of the perforation and the colostomy are performed effectively, addressing the patient's immediate surgical needs.
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The suture of the large intestine (colorrhaphy) with colostomy is indicated for the following conditions:
The procedure for suture repair of the large intestine with colostomy involves several critical steps:
Post-procedure care following the suture of the large intestine with colostomy includes monitoring for any signs of infection, ensuring proper drainage if drains were placed, and managing the colostomy site for any complications. Patients may require education on colostomy care and dietary modifications to support recovery. Follow-up appointments are essential to assess healing and address any concerns related to the surgical site or colostomy function.
| Short Descr | REPAIR OF BOWEL LESION | Medium Descr | SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY | Long Descr | Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); with colostomy | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 72 - Colostomy, temporary and permanent |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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