CODING REIMBURSE- MENT AND COST CARE PATH DIAGRAM PROCEDURE CODING PATIENT SCENARIO HISTORY Point of Care Targeted by Seprafilm TM 1 © Premier Innovation

CODINGREIMBURSE-MENT ANDCOST

CARE PATHDIAGRAM

PROCEDURECODING

PATIENTSCENARIOHISTORY

Point of Care Targeted by SeprafilmTM Point of Care Targeted by SeprafilmTM

1

© Premier Innovation Institute 2000. All rights reserved. These materials may not be reprinted or republished in any form without the express written consent of the Premier Innovation Institute.

[Insert Scenario Description]

PATIENT SCENARIO

Total Cost = $______


CARE PATHDIAGRAM

PROCEDURECODING



2


SurgicalTreatmentSurgical

Treatment

PATIENT WORKSHEET 1.0: COLON CANCER AND NEOPLASMSOverview of all diagnosis and procedures.

NOTE: THE FOLLOWING HOLDS TRUE FOR EVERY SCENARIO: REIMBURSEMENTS ARE NOT A REQUIRED FIELD. NOT ALL HOSPITALS PROVIDE ACCURATE REIMBURSEMENTS. THEY DO NOT EVEN PROVIDE ESTIMATED REIMBURSEMENTS. A MEDICARE REIMBURSEMENT SCHEDULE MAY BE MORE ACCURATE SINCE SOME OF THESE STATISTICS MAY BE UNDERREPORTED.

Recurrence ofPrimary DiseaseRecurrence of

Primary Disease

153.0 Hepatic Flexure153.1 Transverse Colon153.2 Descending Colon153.3 Sigmoid Colon153.4 Cecum153.6 Ascending Colon153.7 Splenic Flexure 153.8 Colon NEC153.9 Colon NOS154.0 Rectosigmoid JCT159.0 Intestine NOS

46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy46.21 Temporary Ileostomy45.7 Partial Large Bowel Excision54.59 Lysis of Adhesions (Abdomen)

Pharm IV FluidPharm IV TPNLabs Blood WorkLabs All other excluding Blood workRad Plain Abd X-ray

Contrast Upper/LowerRad Chest X-rayPharm AntibioticsPharm All other MedsRad CT Scan (Abdomen)

45.75 Left Hemicolectomy45.73 Right Hemicolectomy45.8 Total Intra-Abd Colectomy45.74 Transverse Colon Resect45.76 Sigmoidectomy46.03 Loop Colostomy

(Exterz Large Intestine)46.10 Colostomy NOS46.11 Temporary Colostomy46.21 Temporary Ileostomy54.59 Lysis of Adhesions (Abdomen)

Subsequent Procedures



Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge

Complication*Complication*


Small BowelObstruction


PlannedSubsequent Procedures



Treatment

MedicalTreatmentMedical

Treatment

45.75 Left Hemicolectomy45.73 Right Hemicolectomy45.8 Total Intra-Abd Colectomy45.74 Transverse Colon Resect45.76 Sigmoidectomy46.10 Colostomy NOS48.69 Closure of HartmanXX.XX NG Suction54.59 Lysis of Adhesions (Abdomen46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy46.21 Temporary Ileostomy)

AdjuvantTherapyAdjuvantTherapy


Primary Disease

Other DiseaseProcesses


553.21 Incisional Hernia

OtherComplications

OtherComplications

AnastomoticProblems

AnastomoticProblems

997.4 Anastomotic Leak997.4 Anastomotic Stricture998.11 Post-op Hemorrhage

V55.2 Attention to IleostomyV55.3 Attention to Colostomy



54.59 Lysis of Adhesions (Abdomen)45.60 Other Small Bowel Excision46.01 Loop Ileostomy46.03 Loop Colostomy46.11 Temporary Colostomy46.20 Ileostomy46.21 Temporary Ileostomy46.51 Intestinal Stoma Closure45.90 Intestinal Anastimosis


CARE PATHDIAGRAM

PROCEDURECODING



3


PATIENT WORKSHEET 1.1: COLON CANCER AND NEOPLASMSA 70-year-old man presents with nausea, vomiting, and abdominal distention. He has guiac positive stool and has a dilated right colon on abdominal x-rays. A water-soluble contrast enema demonstrates an obstruction. The patient has an urgent abdominal colectomy, ileostomy and a Hartman’s closure of his rectum. He is discharged on POD #7. Two months later, he has an ileostomy taken down and an ileorectal anastomosis is performed. He recovered from both operations without complications. He is discharged on POD #4.

AnastomoticProblems

AnastomoticProblems




Treatment

InitialComplication

InitialComplication

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment



Primary Disease


Primary Disease





153.4 Colon cancer

P 45.8 Total Intra-Abd Colectomy**NO PATIENTS FOUND WITH EITHER SECONDARY PROCEDURE USING THESE CODES.**S 4X.XX Hartman Resection of RectumS 46.21 Temporary Ileostomy

8 patientsALOS 10.75 $13,681 (Cost)

56 PatientsALOS 3.89

$4,693 (Cost)

P 46.51 Closure stoma small intestine

Total Cost = $18,374

DRG 148Major Small and Large Bowel Procedures with CCAverage National Payment $13,892.03

V55.2 Attention to Ileostomy

DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment $4,769.84

10-15% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



4


PATIENT WORKSHEET 1.2: COLON CANCER AND NEOPLASMS


A 70-year-old man presents with nausea, vomiting, and abdominal distention. He has guiac positive stool and has a dilated right colon on abdominal x-rays. A water-soluble contrast enema demonstrates an obstruction. The patient has an urgent abdominal colectomy, ileostomy and a Hartman’s closure of his rectum. He is discharged on POD #7. Two months later, he has an ileostomy taken down with lysis of adhesions and an ileorectal anastomosis is performed. He is discharged on POD #7.

AnastomoticProblems

AnastomoticProblems




Treatment

InitialComplication

InitialComplication

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment



Primary Disease


Primary Disease



P 46.51 Closure Stoma small intestine S 54.59 Lysis of Adhesions



2 PatientsALOS 6.5

$ 7,476 (Cost)

P 45.8 Total Intra-Abd Colectomy**NO PATIENTS FOUND WITH EITHER SECONDARY PROCEDURE USING THESE CODES.**S 48.69 Closure of HartmanS 46.21 Temporary Ileostomy

153.4 Colon Cancer


8 patientsALOS 10.75 $13,681 (Cost)

DRG 150Peritoneal Adhesiolysis without CCAverage National Payment $11,114.69

10-15% Incidence



CARE PATHDIAGRAM

PROCEDURECODING



5




A 70-year-old man presents with nausea, vomiting, and abdominal distention. He has guiac positive stool and has a dilated right and transverse colon on abdominal x-rays. A water-soluble contrast enema demonstrates an obstruction sigmoid cancer. The patient has an urgent sigmoid colectomy with a left colon colostomy and a Hartman’s closure of his rectum. Two months after this operation he has his colostomy taken down. On POD #4 he is given liquids and develops nausea and abdominal distention. Abdominal x-rays suggest a partial small bowel obstruction. This is treated with nasogastric suction and intravenous fluids. After 3 days the patient passes gas and his distention resolves. He resumes his diet and is discharged on POD #9.



DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge






Treatment


Treatment



Treatment


Primary Disease

AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications


Primary Disease



InitialComplication

InitialComplication





Pharm IV TPNPharm AntibioticsPharm Other MedsX-ray Plain Abd

(S800XR1000 )

$62.80 XRay

$396.79 IV TPN124 patientsALOS 5.65

$ 5,609 (Cost)

153.3 Sigmoid Colon

P 45.76 SigmoidectomyS 46.11 Temporary ColostomyS 4X.XX Hartman Resection of Rectum**DID NOT FIND ANY PATIENTS WITH SECOND SECONDARY PROCEDURE USING THAT CODE.**

13 patientsALOS 14.69

$15,722 (Cost) $738 Antibiotics

$1,756 Other Meds

(Tests/Meds already included in procedures)


P 46.52 Closure stoma large intestine

V55.3 Attention to colostomy


10-15% Incidence


$2,568 (Cost)

DRG 181GI Obstruction without CCAverage National Payment $2,133.64

P 96.07 Non operative Insert naso-gastric tube

560.9 SBO


Treatment


CARE PATHDIAGRAM

PROCEDURECODING



6




A 70-year-old man presents with nausea, vomiting, and abdominal distention. He has guiac positive stool and has a dilated right and transverse colon on abdominal x-rays. A water-soluble contrast enema demonstrates an obstruction sigmoid cancer. The patient has an urgent sigmoid colectomy with a left colon colostomy and a Hartman’s closure of his rectum. Two months after this operation he has his colostomy taken down. On POD #4 he is given liquids and develops nausea and abdominal distention. Abdominal x-rays suggest small bowel obstruction. Small bowel obstruction diagnosed. Patient is surgically treated. Lysis of adhesions. He is discharged on POD #19.



DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge






Treatment


Treatment



Treatment


Primary Disease

AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications


Primary Disease




TreatmentInitial

ComplicationInitial

Complication






$ 5,609 (Cost)

153.3 Sigmoid Colon

P 45.76 SigmoidectomyS 46.11 Temporary ColostomyS 4X.XX Hartman Resection of Rectum**DID NOT FIND ANY PATIENTS WITH SECOND SECONDARY PROCEDURE USING THAT CODE.**


$15,722 (Cost)



V55.3 Attention to colostomy


10-15% Incidence


$10,633 (Cost)

DRG 150Peritoneal Adhesiolysis with CCAverage National Payment $11,114.69

P 560.9 Small Bowel Obstruction

P 54.59 Lysis of Adhesions (Abdomen)


CARE PATHDIAGRAM

PROCEDURECODING



7



Total Cost = $6,462

A 65-year-old women presents with fatigue and melana. A colonoscope reveals a 6 cm lesion of the cecum. She undergoes a right hemicolectomy with ileocolic anastomosis. She has an uneventful recovery and is discharged on POD #6.

50-75% Incidence

153.4 Cecum Cancer

P 45.73 Right Hemicolectomy

AnastomoticProblems

AnastomoticProblems




Treatment

InitialComplication

InitialComplication

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment





Primary Disease


Primary Disease




$ 6,462 (Cost)

DRG 149Major Small and Large Bowel Procedures without CCAverage National Payment $6,352.95


CARE PATHDIAGRAM

PROCEDURECODING



8




Total Cost = $9,868

A 51-year-old woman is found with a large sessile polyp on screening flexible sigmoidoscopy. Colonoscopy reveals no other lesions, but the polyp is too big to remove with a colonoscope. She undergoes a sigmoid colectomy without complications. She is discharged on POD #6. Two years later, she develops RUQ abdominal pain and is found to have cholethiasis. She undergoes an uneventful cholecystectomy. She is discharged on POD #3.

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge






Treatment


Treatment


Treatment


Primary Disease


Treatment

AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications




Primary Disease





51.23 Laparascopic Cholecystectomy



DischargeDischarge


$6,108 (Cost)


$3,760 (Cost)

153.3 Sigmoid 57410 Calculus of gallbladder with other cholecystitis, without mention of obstruction

DRG 494 Laparoscopic Cholecystectomy without Common Duct without CCAverage National Payment $3,854.00


50-75% Incidence

P 45.76 Sigmoidectomy


CARE PATHDIAGRAM

PROCEDURECODING



9





A 51-year-old woman is found with a large sessile polyp on screening flexible sigmoidoscopy. Colonoscopy reveals no other lesions, but the polyp is too big to remove with a colonoscope. She undergoes a sigmoid colectomy without complications. She is discharged on POD #6. Two years later, she develops RUQ abdominal pain. A CT scan reveals a solitary liver metastasis. She has a right lobectomy of her liver and is discharged two weeks later. Discharged POD #9.

50.3 Right Hepatic Lobectomy

DischargeDischarge

DischargeDischarge

DischargeDischarge






Treatment


Treatment


Treatment

DischargeDischarge

OtherComplications

OtherComplications




Primary Disease





InitialComplication

InitialComplication



Rad CT Scan (abdomen)S800CT1000 CT scan of abdomen w and w/o contrast


Primary Disease

AnastomoticProblems

AnastomoticProblems


Treatment

$187.9288 PatientsALOS 6.15

$6,108 (Cost)

197.7 Liver Metastasis

P 45.76 Sigmoidectomy


$14,086 (Cost)

153.3 Sigmoid

(Test already included in procedures)


DRG 191 Pancreas, Liver and Shunt Procedures with CCAverage National Payment $17,830.90

50-75% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



10



46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosis46.10 Colostomy NOS48.69 Closure of HartmanXX.XX NG Suction54.59 Lysis of Adhesions (Abdomen) 46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy

PATIENT WORKSHEET 2.0: RECTAL CANCER

153.0 Hepatic Flexure153.1 Transverse Colon153.2 Descending Colon153.3 Sigmoid Colon153.4 Cecum153.5 Appendix153.6 Ascending Colon153.7 Splenic Flexure153.8 Colon NEC153.9 Colon NOS154.0 Neoplasm Colon154.1 Rectum154.8 Rectum/Anus NEC159.0 Intestine NOS

48.41 Soave submucosal Rectal Pull Through

48.49 Other Rectal Pull Through48.5 Abd-Perineal Rectum Resection48.62 Anterior Rectum Resection

w/Colostomy48.69 Rectal Resection NEC48.63 Anterior Rectum Resection NEC46.03 Loop Colostomy (Exterz Large

Intestine)46.10 Colostomy NOS46.11 Temporary Colostomy46.21 Temp Ileostomy54.59 Lysis of Adhesions (Abdomen)XX.XX Small Bowel Suspension w/Sling

997.4 Anastomotic Leak998.11 Post-op Hemorrhage

54.59 Lysis of Adhesions (Abdomen)45.60 Small Bowel Resection46.01 Loop Ileostomy46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temp. Ileostomy46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosis

46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy45.70 Partial resection of Large Intestine54.59 Lysis of Adhesions (Abdomen)

AnastomoticProblems

AnastomoticProblems



InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment




Primary Disease


Primary Disease




Treatment

Overview of all diagnosis and procedures.


OtherComplications

OtherComplications

V55.2 Attention to Ileostomy V55.3 Attention to Colostomy


Treatment

Pharm IV FluidPharm IV TPNLabs BloodworkLabs All other excluding Blood workRad Plain Abd X-rayRad CT Scan (Abdomen)Pharm Coumadin (aka Warfarin), HeparinPharm AntibioticsPharm All other Meds


CARE PATHDIAGRAM

PROCEDURECODING



11


PATIENT WORKSHEET 2.1: RECTAL CANCERA 68-year-old man presents with rectal bleeding. A colonocsope reveals a 4 cm lesion of the rectum. He receives a low anterior resection. He has an uneventful recovery and is discharged on POD #7. Pathology revealed the tumor to be a T3N1 tumor. The patient received adjuvant chemoradiation.

154.1 Malignant Neoplasm Rectum

AnastomoticProblems

AnastomoticProblems



InitialComplication

InitialComplication

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment




Primary Disease


Primary Disease




Treatment

P 48.63 Anterior Rectum Resection NEC

25 PatientsALOS 6.8

$7,029 (Cost)

Total Cost = $7,530

V58.1 Chemotherapy

P 99.25 Chemoradiation

136 PatientsALOS 0 (outpatient)

$501 (Cost)

DRG 147Rectal Resection without CCAverage National Payment $6,512.85

No DRG - Outpatient procedure

50-75% Incidence



CARE PATHDIAGRAM

PROCEDURECODING



12





DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge






Treatment


Treatment


Treatment




Primary Disease


Treatment


25 PatientsALOS 6.8

$7,029 (Cost)


V58.1 Chemotherapy



$501 (Cost)



50-75% Incidence




Primary Disease



AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications




2 PatientsALOS5.6.50

$ 7,476 (Cost)



InitialComplication

InitialComplication


CARE PATHDIAGRAM

PROCEDURECODING



13




AnastomoticProblems

AnastomoticProblems



InitialComplication

InitialComplication

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment


Primary Disease


Primary Disease




Treatment


25 PatientsALOS 6.8

$7,029 (Cost)


V58.1 Chemotherapy



$501 (Cost)



50-75% Incidence





(S800XR1000 )

560.9 SBO



657 PatinetsALOS 3.68

$2,568 (Cost)

$62.80 XRay


$396.79 IV TPN

$738 Antibiotics

$1,756 Other Meds


CARE PATHDIAGRAM

PROCEDURECODING



14





AnastomoticProblems

AnastomoticProblems



InitialComplication

InitialComplication

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment


Primary Disease


Primary Disease




Treatment


25 PatientsALOS 6.8

$7,029 (Cost)


V58.1 Chemotherapy



$501 (Cost)



50-75% Incidence




$10,633 (Cost)





CARE PATHDIAGRAM

PROCEDURECODING



15



PATIENT WORKSHEET 2.5: RECTAL CANCERA 70-year-old man presents with anal pain and bleeding. Evaluation reveals a lesion. He received an abdominal perineal resection. He is discharged on POD #10. The patient received adjuvant chemoradiation.



InitialComplication

InitialComplication

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment




Primary Disease


Primary Disease




Treatment

AnastomoticProblems

AnastomoticProblems

P 48.5 Abdominoperin Rectum Resection


$11,900 (Cost)


P 154.1 Malignant Neoplasm Rectum

V58.1 Chemotherapy




$501 (Cost)

DRG 146Rectal Resection with CCAverage National Payment $11,215.96

50-75% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



16


PATIENT WORKSHEET 2.6: RECTAL CANCERA 63-year-old woman undergoes a low anterior resection for a rectal cancer. On POD #4, she develops a fever and abdominal pain. A water-soluble contrast enema demonstrates a leaking anastomosis. She receives an end colostomy and Hartman’s closure of her rectum. Three months later, she undergoes takedown of her colostomy with a colorectal anastomosis.




DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge



Treatment


Treatment




Primary Disease


Primary Disease





Treatment

AnastomoticProblems

AnastomoticProblems


Treatment

P V55.3 Attention to Colostomy




InitialComplication

InitialComplication

P 48.62 Anterior Rectum Resection w/ Colostomy

**NO PATIENTS FOUND WITH A SECONDARY DIAGNOSIS OF 48.69 - Rectum Resection


$12,297 (Cost)

Contrast Enema (Lower GI series) **NOT ABLE TO BREAK OUT COST SEPARATELY**


$5,609 (Cost)




P 154.1 Malignant Neoplasm RectumS 997.4 Anastomotic Leak

DRG 146Rectal Resection with CCAverage National Payment $11,215.96


15-25% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



17


45.75 Left Hemicolectomy45.73 Right Hemicolectomy45.8 Total Intra-Abd Colectomy45.74 Transverse Colon Resect45.76 Sigmoidectomy46.03 Loop Colostomy (Exterz Large Intestine)46.10 Colostomy NOS46.11 Temporary Colostomy48.62 Anterior Rectum Resection w/Colostomy48.63 Anterior Rectum Resection NEC54.59 Lysis of Adhesions (Abdomen)

562.10 Diverticulosis of Colon562.11 Diverticulitis of Colon562.12 Diverticulosis of Colon with Hemorrhage562.13 Diverticulitis of Colon with Hemorrhage

PATIENT WORKSHEET 3.0: DIVERTICULAR DISEASE

46.03 Loop Colostomy46.1 Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy45.7 Partial Large Bowel Excision

AnastomoticProblems

AnastomoticProblems


Primary Disease




Treatment

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment




46.51 Intestinal Stoma Closure45.9 0 Intestinal Anastomosis46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temp. Ileostomy


Treatment

54.59 Lysis of Adhesions (Abdomen)45.60 Small Bowel Resection46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosis



Treatment



InitialComplication

InitialComplication

Pharm IV FluidPharm IV TPN

Foley (CATH insertion)Labs Blood WorkLabs All other excluding Blood workRad Plain Abd X-ray

Contrast Upper/LowerRad CT Scan (Abdomen)Pharm Water Soluble Contrast

Upper/Lower EndoscopyPharm Antibiotics and Meds553.21 Incisional Hernia



CARE PATHDIAGRAM

PROCEDURECODING



18


A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. The patient has 3 previous episodes of left lower quadrant pain and has been hospitalized once before to receive antibiotics. Colonoscopy showed no other lesion one year ago. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Discharged POD #10. Six months later the patient returned to the operating room for colostomy closure. He is discharged POD #6.


P 46.52 Closure stoma of large intestine


Primary Disease



InitialComplication

InitialComplication

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment

AnastomoticProblems

AnastomoticProblems





$216.58 CT Scan

$454.19 Blood work

562.11 Diverticulitis of Colon


Treatment

P 45.75 Left HemicolectomyS 46.11 Temporary Colostomy


$12,786 (Cost)


$5,609 (Cost)

(Tests already included in procedures)Total Cost = $18,395

Rad CT ScanS800CT1001 - CT Scanabdomen w/contrastLAB Blood Work



DRG 153Minor Small and Large Bowel Procedures without CCAverage National Payment$ 4,769.94

10-15% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



19


A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. The patient has 3 previous episodes of left lower quadrant pain and has been hospitalized once before to receive antibiotics. Colonoscopy showed no other lesion one year ago. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Discharged POD #10. Six months later the patient returned to the operating room for colostomy closure. Adhesions are encountered and lysed. Patient is discharged on POD #9.



Primary Disease



InitialComplication

InitialComplication

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment

AnastomoticProblems

AnastomoticProblems





$216.58 CT Scan

$454.19 Blood work



Treatment

P 45.75 Left HemicolectomyS 46.11 Temporary ColostomyS 4X.XX Hartman Resection of Rectum


$12,786 (Cost)

(Tests already included in procedures. Italicized costs are not included.)Total Cost = $22,464


V55.3 Attention to Colostomy


10-15% Incidence

P 46.52 Closure Stoma large intestine S 54.59 Lysis of Adhesions

69 PatientsALOS9.07

$ 9,678 (Cost)



CARE PATHDIAGRAM

PROCEDURECODING



20


A 72-year-old woman is admitted with massive lower GI hemorrhage. An angiogram revealed left-sided diverticuli with rapid bleeding. Vasopressin was used to stop the bleeding, and colonoscopy was performed after a rapid bowel prep. Diverticuli were noted throughout the sigmoid and left colon. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Discharged POD #15. Six months later the patient returned to the operating room for colostomy closure through a major laparotomy incision. Seven days after left colectomy, the patient develops abdominal distension, nausea, and WBC of 14,000. Abdominal x-ray suggests partial SBO- this is treated with NG suction; and IV fluids. After 3 days distention resolves. Patient is discharged on POD #8.



Primary Disease




Treatment

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge










Treatment


Treatment


Treatment

AnastomoticProblems

AnastomoticProblems



Pharm IV FluidLAB Blood Work

InitialComplication

InitialComplication



$151.61 IV fluid

$10.57 Blood work

P 45.76 SigmoidectomyS 46.11 Temporary Colostomy**NO PATIENTS FOUND WITH SECONDARY PROCEDURE OF RECTUM RESECTIONS 4X.XX Hartman Resection of Rectum


$34,840 (Cost)


$7,306 (Cost)


562.12 Diverticulosis of Colon with Hemorrhage



10-15% Incidence

$62.80 XRay

$396.79 IV TPN

$738 Antibiotics

$1,756 Other Meds


$2,568 (Cost)

560.9 SBO




(S800XR1000 )



CARE PATHDIAGRAM

PROCEDURECODING



21


A 72-year-old woman is admitted with massive lower GI hemorrhage. An angiogram revealed left-sided diverticuli with rapid bleeding. Vasopressin was used to stop the bleeding, and colonoscopy was performed after a rapid bowel prep. Diverticuli were noted throughout the sigmoid and left colon. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Discharged POD #15. Six months later the patient returned to the operating room for colostomy closure through a major laparotomy incision. Seven days after left colectomy, the patient develops abdominal distension, nausea, and WBC of 14,000. NG suction, IV fluid -- after two days and after initial symptoms show no progress, SBO diagnosed -- Lysis of Adhesion. Patient is discharged on POD #18.




Primary Disease




Treatment

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge










Treatment


Treatment


Treatment

AnastomoticProblems

AnastomoticProblems



Pharm IV FluidLAB Blood Work

InitialComplication

InitialComplication



$151.61 IV fluid

$10.57 Blood work

P 45.76 SigmoidectomyS 46.11 Temporary Colostomy**NO PATIENTS FOUND WITH SECONDARY PROCEDURE OF RECTUM RESECTIONS 4X.XX Hartman Resection of Rectum


$34,840 (Cost)


$7,306 (Cost)


$10,633 (Cost)


562.12 Diverticulosis of Colon with Hemorrhage





10-15% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



22




AnastomoticProblems

AnastomoticProblems


Primary Disease




Treatment

InitialComplication

InitialComplication

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge










Treatment


Treatment



A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. When the pain and palpable mass resolved, the patient underwent a left colectomy with primary anastomosis. Patient is discharged on POD#9.


Treatment

P 45.75 Left Hemicolectomy


$11,747 (Cost)



50-75% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



23


A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. The patient has 3 previous episodes of left lower quadrant pain and has been hospitalized once before to receive antibiotics. Colonoscopy showed no other lesion one year ago. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Six months later the patient returned to the operating room for colostomy closure through a major laparotomy incision. Seven days after left colectomy, the patient develops abdominal distension, nausea, fever of 39oC, and WBC of 14,000. A CT scan revealed an abscess in the pelvis with a leak of contrast from the colorectal anastomosis. The patient is returned to the operating room for abdominal washout, repair/revision of the anastomosis, placement of pelvic drains and diverting loop ileostomy. The loop ileostomy is closed eight weeks later after a hypaque enema reveals no leak.




Primary Disease



InitialComplication

InitialComplication

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment

AnastomoticProblems

AnastomoticProblems





$216.58 CT Scan

$454.19 Blood work



Treatment



$12,786 (Cost)


$5,609 (Cost)

46.51 Closure Stoma Small Intestine


$4,693 (Cost)






46.20 Ileostomy NOS

P 997.4 Anastomotic LeakS 569.5 Abscess of intestine **NO PATIENTS FOUND WITH ABSCESS AS SECONDARY DIAGNOSIS.



$21,117 (Cost)

P V55.2 Attention to Ileostomy


10-15% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



24


A 53-year-old moderately obese Missouri farmer presents with a 4-day history of left lower quadrant abdominal pain, fever of 39 oC, and a WBC of 16,000. A CT scan shows a 5 cm abscess in the left lower quadrant adjacent to the sigmoid colon, which has numerous diverticuli. The patient has 3 previous episodes of left lower quadrant pain and has been hospitalized once before to receive antibiotics. Colonoscopy showed no other lesion one year ago. The patient was taken immediately to the operating room where a sigmoid colectomy was performed and a Hartman’s rectal stump with end colostomy were constructed. Six months later the patient returned to the operating room for colostomy closure through a major laparotomy incision. Dense adhesions were encountered and an enterotomy occurred during their division. This was repaired and the colostomy was closed. Four days after this procedure, the patient develops abdominal distension, nausea, fever of 39oC, and WBC of 14,000. A CT scan revealed an abscess in the pelvis with a leak of contrast from the small bowel. The patient is returned to the operating room for abdominal washout, and a diverting ileostomy using the site of the leak. The ileostomy is closed eight weeks later.




Primary Disease



InitialComplication

InitialComplication

DischargeDischarge

OtherComplications

OtherComplications

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment

AnastomoticProblems

AnastomoticProblems





$216.58 CT Scan

$454.19 Blood workToo High?



Treatment



$12,786 (Cost)


$5,609 (Cost)

46.51 Closure Stoma Small Intestine


$4,693 (Cost)






46.20 Ileostomy NOS

P 997.4 Anastomotic LeakS 569.5 Abscess of intestine **NO PATIENTS FOUND WITH ABSCESS AS SECONDARY DIAGNOSIS.



$21,117 (Cost)

P V55.2 Attention to Ileostomy


10-15% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



25


AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications



863.20 Small Intestine Injury-Closed863.21 Duodenum Injury-Closed863.29 Small Intestine Injury NEC-Closed863.39 Small Intestine Injury Open863.40 Colon Injury NOS-Closed863.41 Ascending Colon Injury-Closed863.42 Transverse Colon Injury-Closed863.43 Descending Colon Injury-Closed863.44 Sigmoid Colon Injury-Closed 863.45 Rectum Injury-Closed863.46 Colon Injury Mult Site-Closed863.49 Colon Injury NEC-Closed863.89 GI Injury NEC-Closed

PATIENT WORKSHEET 4.0: INTESTINAL TRAUMA


46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosys46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy



46.03 Loop Colostomy46.11 Temporary Colostomy46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy46.93 Revision of Small Bowel Anastomosis46.94 Rev of Large Bowel Anastomosis45.7 Partial Large Bowel Excision




Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge






Treatment




Treatment

54.59 Lysis of Adhesions (Abdomen)45.60 Small Bowel Resection46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosis




Treatment





Upper/Lower EndoscopyPharm Antibiotics and Meds

45.61 Multiple Seg Small Bowel Excision45.71 Multiple Seg Large Bowel Excision45.72 Cectomy45.73 Right Hemicolectomy45.74 Transverse Colectomy45.75 Left Hemicolectomy45.76 Sigmoidectomy46.03 Loop Colostomy45.8 Total Intra Abd Colectomy46.10 Colostomy NOS46.11 Temporary Colostomy48.62 Anterior Rectum Resection w/Colostomy48.63 Anterior Rectum Resection NEC48.69 Other resection Rectum48.5 Abd-Perineal Rectum Resection48.79 Repair of Rectum NEC45.61 Multiple segmental resection of small

intestine45.62 Other partial resection of small intestine46.75 Suture Large Bowel Laceration46.73 Small Bowel Suture NEC


CARE PATHDIAGRAM

PROCEDURECODING



26


PATIENT WORKSHEET 4.1: INTESTINAL TRAUMAA 22-year-old man sustains a gunshot wound to the abdomen. At abdominal exploration, he has a hole in his colon and two small bowel injuries. He receives a small bowel resection, an end sigmoid colostomy, and Hartman’s closure of his rectum. He is discharged on POD #7. Two months later his colostomy is closed. He is discharged on POD #6.

** DID NOT FIND ANY PATIENTS WITH EITHER OF THESE DIAGNOSIS *863.44 Sigmoid Colon Injury-Closed 863.89 GI Injury NEC-ClosedUSED 863.30 - Injury unspecified site with open wound cavity


AnastomoticProblems

AnastomoticProblems






Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment




Treatment


Treatment

P V55.3 Attention to colostomy

OtherComplications

OtherComplications

*DID NOT FIND THIS PROCEDURE AS EITHERPRINCIPAL OR SECONDARY* 48.62 Anterior Rectum Resection w/ ColostomyP 45.62 Other Small Bowel ExcisionS 46.79 Other repair of intestine


$10,232 (Cost)


$5,609 (Cost)




15-25% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



27


PATIENT WORKSHEET 4.2: INTESTINAL TRAUMAA 22-year-old man sustains a gunshot wound to the abdomen. At abdominal exploration, he has a hole in his colon and two small bowel injuries. He receives a small bowel resection, an end sigmoid colostomy, and Hartman’s closure of his rectum. He is discharged on POD #7. Two months later his colostomy is closed. Adhesions are encountered and lysed. He is discharged on POD #9.


AnastomoticProblems

AnastomoticProblems






Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment




Treatment


TreatmentOther

ComplicationsOther

Complications



$10,232 (Cost)



15-25% Incidence

P 46.52 Closure Stoma large intestine S 54.59 Lysis of Adhesions


$ 9,678 (Cost)


V55.3 Attention to Colostomy


CARE PATHDIAGRAM

PROCEDURECODING



28


PATIENT WORKSHEET 4.3: INTESTINAL TRAUMAA 22-year-old man sustains a gunshot wound to the abdomen. At abdominal exploration, he has a hole in his colon and two small bowel injuries. He receives a small bowel resection, an end sigmoid colostomy, and Hartman’s closure of his rectum. He is discharged on POD #7. Two months later his colostomy is closed. On POD #4, he develops nausea and distension. X-ray suggests a partial small bowel obstruction. This is treated with NG suction and IV fluids. After 3 days, the patient passes gas and his distention is resolved. He is discharged on POD #9.



AnastomoticProblems

AnastomoticProblems






Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment




Treatment


Treatment


OtherComplications

OtherComplications


4 PatientsALOS 11.75$10,232 (Cost)


$5,609 (Cost)




15-25% Incidence

560.9 SBO



$2,568 (Cost)


$62.80 XRay

$396.79 IV TPN

$738 Antibiotics

$1,756 Other Meds


(S800XR1000 )



CARE PATHDIAGRAM

PROCEDURECODING



29


PATIENT WORKSHEET 4.4: INTESTINAL TRAUMAA 22-year-old man sustains a gunshot wound to the abdomen. At abdominal exploration, he has a hole in his colon and two small bowel injuries. He receives a small bowel resection, an end sigmoid colostomy, and Hartman’s closure of his rectum. He is discharged on POD #7. Two months later his colostomy is closed. Four days after procedure, patient develops abdominal distention and nausea. Abdominal x-ray reveals small bowel obstruction. Patient is operated for small bowel obstruction and lysis of adhesion. Patient is discharged on POD #18.



AnastomoticProblems

AnastomoticProblems






Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment




Treatment


Treatment


OtherComplications

OtherComplications



$10,232 (Cost)


$5,609 (Cost)




15-25% Incidence


$10,633 (Cost)





CARE PATHDIAGRAM

PROCEDURECODING



30


PATIENT WORKSHEET 5.0: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASE

45.79 Resection of Colon45.8 Total Colectomy48.49 Rectal Pull Through48.5 Abd-Perineal Rectum Resection45.95 Endo Rectal Ileal Pouch46.01 Loop Ileostomy46.20 Ileostomy46.21 Temporary Ileostomy46.22 Continent Ileostomy54.59 Lysis of Adhesions (Abdomen)

556.3 Ulcerative556.4 Left Sided UC556.6 Universal UC556.8 Other UC211.2 Familial PolyposisXXXX HNPCC

46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temp. Ileostomy45.95 Endo Rectal Ileal Pouch54.59 Lysis of Adhesions (Abdomen)

AnastomoticProblems

AnastomoticProblems






Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge






TreatmentPlanned



46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosis45.79 Resection of Colon45.8 Total Colectomy48.49 Rectal Pull Through48.5 Abd-Perineal Rectum Resection45.95 Endo Rectal Ileal Pouch46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy46.22 Continent Ileostomy54.59 Lysis of Adhesions (Abdomen)






Treatment

54.59 Lysis of Adhesions (Abdomen)45.60 Small Bowel Resection46.51 Intestinal Stoma Closure45.90 Intestinal Anastomosis54.59 Lysis of Adhesions (Abdomen)



Treatment


OtherComplications

OtherComplications




Upper/Lower EndoscopyPharm Antibiotics and Meds


CARE PATHDIAGRAM

PROCEDURECODING



31


PATIENT WORKSHEET 5.1: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASEAn 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. She receives restorative proctocolectomy and an ileal J pouch, ileoanal anastomosis, and loop ileostomy. Discharge POD #9. Her ileostomy is closed two months after her initial operation when a hypaque enema shows no leak. Discharge POD #4.

AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications





InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge






Treatment


Treatment




Treatment



556.6 Universal UC

P 45.8 Total ColectomyS 45.95 Endo Rectal Ileal PouchS 46.01 Loop Ileostomy


Treatment

P 46.51 Closure Intestinal StomaS 87.64 Hypaque Enema (Lower GI Series)


$20,758 (Cost)


$4,693 (Cost)



P V55.2 Attention to ileostomy

DRG 153Minjor Small and Large Bowel Procedures without CCAverage National Payment $4,769.94

90% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



32


PATIENT WORKSHEET 5.2: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASEAn 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. She receives restorative proctocolectomy and an ileal J pouch, ileoanal anastomosis, and loop ileostomy. Discharge POD #16. Her ileostomy is closed two months after her initial operation. Adhesions are encountered and lysed. Discharge POD #7.

AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications





InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge






Treatment


Treatment




Treatment



556.6 Universal UC



Treatment


$20,758 (Cost)



90% Incidence



$ 7,476 (Cost)




CARE PATHDIAGRAM

PROCEDURECODING



33


PATIENT WORKSHEET 5.3: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASEAn 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. She receives restorative proctocolectomy and an ileal J pouch, ileoanal anastomosis, and loop ileostomy. Discharge POD #16. Her ileostomy is closed two months after her initial operation. Three days after procedure, patient develops abdominal distention and nausea. X-ray reveals partial small bowel obstruction, which is treated with NG suction and IV fluid. Three days after diagnosis, patient passes gas and distention resolves. Discharge POD #8.

AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications





InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge






Treatment


Treatment




Treatment



556.6 Universal UC



Treatment



$28,758 (Cost)


$4,693 (Cost)





90% Incidence

560.9 SBO



$2,568 (Cost)


$62.80 XRay

$396.79 IV TPN

$1,756 Other Meds


(S800XR1000 )


$738 Antibiotics


CARE PATHDIAGRAM

PROCEDURECODING



34


PATIENT WORKSHEET 5.4: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASEAn 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. She receives restorative proctocolectomy and an ileal J pouch, ileoanal anastomosis, and loop ileostomy. Discharge POD #16. Her ileostomy is closed two months after her initial operation. Seven days after procedure, patient experiences abdominal distention, nausea, and WBC 14,000. X-ray reveals small bowel obstruction and lysis of adhesion. Discharge POD #17.

AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications





InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge






Treatment


Treatment




Treatment



556.6 Universal UC



Treatment



$20,758 (Cost)


$4,693 (Cost)





90% Incidence



$10,633 (Cost)




CARE PATHDIAGRAM

PROCEDURECODING



35


PATIENT WORKSHEET 5.5: ULCERATIVE COLITIS and FAMILIAL POLYPOSIS DISEASEAn 18-year-old female student develops severe abdominal pain, distension, bloody diarrhea, and elevated WBC. A short flexible sigmoidoscopy reveals acute severe fulminant colitis—either ulcerative colitis or Crohn’s Disease. The patient fails to respond to medication over the next 48 hours and begins to deteriorate with fever, peritoneal signs, and sepsis. Total abdominal colectomy with ileostomy and Hartman’s stump of rectum are performed emergently. The patient improves. Discharge POD #4. Three months later undergoes completion proctectomy with ileal J pouch and ileoanal anastomosis with loop ileostomy. Discharge POD #7. The ileostomy is closed three months later. Discharge POD #4. One year after ileostomy closure, the patient complains of incomplete evacuation of the pouch requiring 20 trips to the toilet daily. Examination reveals a narrowed 3 cm long segment of the pouch just proximal to the staple line of the anastomosis. Daily self intubations of the pouch with a catheter to empty the pouch. Discharge POD #4.

AnastomoticProblems

AnastomoticProblems





InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge






TreatmentPlanned




Treatment


Treatment

OtherComplications

OtherComplications

Second PlannedSubsequent Procedure

Second PlannedSubsequent Procedure


Treatment



P 45.8 Total ColectomyS 46.01 Ileostomy P 48.5 Abdominoperin resection

rectum


$31,645 (Cost)


$8,219 (Cost)

46.51 Closure stoma small intestine


$4,693 (Cost)


556.6 Universal UC



DRG 147Rectal resection without CCAverage National Payment $6,512.85

DRG 153Minor small and large bowel procedures without CCAverage National Payment $4,769.94

90% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



36


PATIENT WORKSHEET 6.0: CROHN’S DISEASE (REGIONAL ENTERITIS)

45.79 Resection of Colon45.75 Left Colectomy45.73 Right Hemicolectomy45.76 Sigmoid Colectomy45.62 Partial Small Bowel resection45.8 Total Colectomy48.5 Abd-Perineal Rectum Resection46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy46.79 Other Repair of Intestine46.10 Colostomy46.03 Loop Colostomy54.59 Lysis of Adhesions (Abdomen)


AnastomoticProblems

AnastomoticProblems






Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge






Treatment

46.50 Intestinal Stoma Closure45.90 Intestinal Anastomosis45.79 Resection of Colon45.8 Total Colectomy48.5 Abd-Perineal Rectum Resection46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temporary Ileostomy54.59 Lysis of Adhesions (Abdomen)


Treatment


Treatment


Primary Disease


OtherComplications

OtherComplications






45.79 Resection of Colon45.75 Left Colectomy45.73 Right Hemicolectomy45.76 Sigmoid Colectomy45.62 Partial Small BowelResection45.8 Total Colectomy48.5 Abd-Perineal Rectum Resection46.01 Loop Ileostomy46.20 Ileostomy NOS46.21 Temp. Ileostomy54.59 Lysis of Adhesions (Abdomen)46.51 Intestinal Stoma Closure45.60 Small Bowel Resection45.90 Intestinal Anastomosis

555.0 Small Intestine555.1 Large Intestine555.2 Ileocolitis555.9 Unspecified Site





Upper/Lower Endoscopy

Pharm Antibiotics and Meds


CARE PATHDIAGRAM

PROCEDURECODING



37


AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications



A 24-year-old sales representative of a biotech company develops acute right lower quadrant pain. An upper GI/small bowel follow through subsequently shows 20 cm of inflammatory bowel disease in the terminal ileum to the ileosecal valve. The patient’s symptoms improve only slightly with medication until another acute episode occurs. A CT scan shows phegman in the right lower quadrant adjacent to the cecum. Exploration, ileocolic resection, drains, ileotransverse colon anastomosis and loop ileostomy. Patient discharged POD #9. Ileostomy is closed three months later. Patient is discharged POD#4


555.2 Regional Enteritis of Small Intestine with Large Intestine




Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment


Primary Disease




$9,403 (Cost)

P 45.73 Right HemicolectomyS 46.01 Loop Ileostomy


$4,693 (Cost)

46.51 Closure Stoma small intestine





15% Incidence


CARE PATHDIAGRAM

PROCEDURECODING



38


AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications



A 24-year-old sales representative of a biotech company develops acute right lower quadrant pain. An upper GI/small bowel follow through subsequently shows 20 cm of inflammatory bowel disease in the terminal ileum to the ileosecal valve. The patient’s symptoms improve only slightly with medication until another acute episode occurs. A CT scan shows phegman in the right lower quadrant adjacent to the cecum. Exploration, ileocolic resection, drains, ileotransverse colon anastomosis and loop ileostomy. Patient discharged POD #9. Ileostomy is closed three months later. Adhesion is encountered and lysed. Patient is discharged on POD #7.






Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment


Primary Disease




$9,403 (Cost)




15% Incidence



$ 7,476 (Cost)




CARE PATHDIAGRAM

PROCEDURECODING



39


AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications



A 24-year-old sales representative of a biotech company develops acute right lower quadrant pain. An upper GI/small bowel follow through subsequently shows 20 cm of inflammatory bowel disease in the terminal ileum to the ileosecal valve. The patient’s symptoms improve only slightly with medication until another acute episode occurs. A CT scan shows phegman in the right lower quadrant adjacent to the cecum. Exploration, ileocolic resection, drains, ileotransverse colon anastomosis and loop ileostomy. Patient discharged POD #9. Ileostomy is closed three months later. Four days after procedure, patient develops nausea and abdominal distention. X-ray reveals partial small bowel obstruction. This is treated with NG suction and IV fluids. After 3 days distention resolved and patient is discharged on POD #8.






Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment


Primary Disease




$9,3040 (Cost)



$4,693 (Cost)

46.51 Closure of Intestinal Stoma small intestine





15% Incidence

560.9 SBO


657 PatinetsALOS 3.68

$2,568 (Cost)


$62.80 XRay

$396.79 IV TPN

$738 Antibiotics

$1,756 Other Meds


(S800XR1000 )



CARE PATHDIAGRAM

PROCEDURECODING



40


AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications



A 24-year-old sales representative of a biotech company develops acute right lower quadrant pain. An upper GI/small bowel follow through subsequently shows 20 cm of inflammatory bowel disease in the terminal ileum to the ileosecal valve. The patient’s symptoms improve only slightly with medication until another acute episode occurs. A CT scan shows phegman in the right lower quadrant adjacent to the cecum. Exploration, ileocolic resection, drains, ileotransverse colon anastomosis and loop ileostomy. Patient discharged POD #9. Ileostomy is closed three months later. Seven days after procedure, patient experiences abdominal distention, nausea, and WBC 14,000. X-ray reveals small bowel obstruction and lysis of adhesion. Discharge POD #17.






Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment


Treatment


Treatment


Primary Disease




$9,403 (Cost)



$4,693 (Cost)

46.51 Closure of Intestinal Stoma small intestine





15% Incidence



$10,633 (Cost)




CARE PATHDIAGRAM

PROCEDURECODING



41



Primary Disease

PATIENT WORKSHEET 6.5: CROHN’S DISEASE (REGIONAL ENTERITIS)Five years after a first episode, the now 29-year-old vice president of sales develops nausea and vomiting with an obstructive picture. Recurrent disease with structuring found at the ileocolic anastomosis. Repeat ileocolic resection. ALOS is six days.

AnastomoticProblems

AnastomoticProblems

OtherComplications

OtherComplications






Treatment

InitialComplication

InitialComplication

DischargeDischarge

DischargeDischarge

DischargeDischarge

DischargeDischarge








Treatment




Treatment


Treatment

P 45.73 Right Hemicolectomy

6 PatientsALOS 5.83

$6,879 (Cost)

Total Cost = $6,879


75-80% Incidence


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