by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA
Who knew Ostomy closure, or take down, would cause so much confusion. Ostomies are created by re-routing a tubular body part to the outside of the body and are coded to the root operation of Bypass. But, what happens when the patient no longer needs the ostomy?
Because this was a bypass, it has two ends – the origin of the bypass (internal structure) and the destination of the bypass (external structure). Take down is the reversal of the bypass process and involves restoring both ends, coded to the technique used by the surgeon. Both ends of the bypass need to be “fixed” to eliminate the abnormal route.
- Repair is the root operation that applies when the body part is restored to its anatomic structure and function.
- Supplement would be the appropriate root operation if the body part is repaired with a device.
To accomplish the take down, the surgeon removes any damaged tissue (internal or external) that would prevent a healthy reconnection. The surgeon calls this “freshening the edges” and this operative step is included in the repair.
The surgeon then repairs or supplements the internal and external body parts. The internal structure can be any tubular body part, but is most commonly the large intestine or the trachea. The external structure is one of two places, the abdominal wall (colostomy, ileostomy) or the neck (tracheostomy). The external opening must be repaired because the surgeon did not create the opening as part of his surgical approach.
Let me illustrate with two common examples:
Example 1: Take down of an ileostomy, with or without a parastomal hernia
- Repair ileum
- Repair or Supplement abdominal wall in the Anatomical Regions, General body system
Example 2: Take down of tracheostomy
- Repair or Supplement the trachea (commonly supplemented with cartilage or synthetic material)
- Repair neck in the Anatomical Regions, General body system
BEWARE! The repair of the abdominal wall or neck is coded with an open approach because the ostomy was a “through-and-through” connection from the inside to the outside. Be sure to select the row in the table with the open approach and not the row with the qualifier of 2, stoma, which has only an external approach.