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A patient with severe diverticulitis in the sigmoid colon presents to surgery for a partial colectomy. The physician performs an exploratory laparoscopic laparotomy to verify the location of the diverticulitis. Once identified, it was noted that there was bleeding from the diverticulitis. The physician transects the descending colon and then transects at the line of the rectum.
The physician mobilizes the splenic flexure in order to create a colostomy with the proximal portion of the remaining colon. The distal portion of the colon is closed. The physician washes the patient's abdomen with saline, removes all trocars and instruments, and then closes the abdomen with sutures.
What CPT and ICD-10-CM codes are reported?
Procedure Coding (CPT):
44212 -- Laparoscopic partial colectomy with end colostomy and closure of distal segment (Hartmann-type procedure)
Correct because:
Sigmoid/descending colon resection
Proximal colostomy created
Distal rectal stump closed
44213 -- Laparoscopic mobilization of splenic flexure
Separately reportable because:
Mobilization was necessary to exteriorize colon for colostomy
Not bundled into 44212
Modifier not required (no multiple-procedure discount with add-on logic)
Diagnosis Coding (ICD-10-CM):
K57.33 -- Diverticulitis of large intestine with perforation and bleeding, without abscess
Documentation supports:
Diverticulitis
Active bleeding
No abscess reported
Why Other Options Are Incorrect:
A / B -- 44206 = colectomy with anastomosis (not performed)
A / B -- K57.41 includes abscess (not documented)
C -- Missing splenic flexure add-on explanation
CPT & ICD-10-CM Guideline Alignment:
Hartmann procedure anastomosis
Bleeding elevates diagnosis specificity
Splenic flexure mobilization is separately reportable when clinically required
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