02-27-2026
Scenario #1:
- 57 YO married, non-Hispanic, white male presented for colon resection after colonoscopy with biopsy confirmed right colon malignancy.
- Op Report: called the procedure a “right colectomy” with the following description of the procedure:
- The mass can be palpated and appears to be arising from the cecum. I took down the hepatic flexure in this similar fashion. Finally, the mesentery of the right colon was mobilized using the GIA stapler. Once the terminal ileum, cecum, ascending colon, and right colon was mobilized, I was able to divide the colon and performed an extended right colectomy. I was able to anastomosis the small bowel to the mid transverse colon using a GIA stapler. The specimen which comprised of the cecum appendix terminal ileum and ascending colon was passed off as specimen.
Question: How would you code this surgery?
- B300 Partial colectomy, removal of one or more segments with colon resection but less than half of colon is removed
- B400 Hemicolectomy (total right or left colon and a portion of the transverse colon)
- B800 Colectomy, NOS
Answer: B400 Hemicolectomy
Rationale:
SEER Program Coding and Staging Manual/STORE-Instructs registrars to use the entire operative report as the primary document to assign the most appropriate surgery code based on what was actually performed. Both STORE Appendix A and SEER Appendix C provide detailed descriptions of the colon surgery codes.
B400 Hemicolectomy (total right or left colon and a portion of the transverse colon)
Note: Code B400 includes removal of the total right or left colon with a portion of the transverse colon
A total right hemicolectomy includes removal of the cecum (with appendix, if present), ascending colon and the hepatic flexure
In this scenario the surgeon, in the description of the procedure, stated it was an extended right colectomy and described creating an anastomosis between the small bowel and mid-transverse colon indicating both the hepatic flexure and a portion of the transverse colon had been removed.
Scenario #2:
- 73 YO widowed, non-Hispanic, white female presented for colon resection after imaging was clinically diagnostic of an ascending colon malignancy.
- Op report called the procedure a “right hemicolectomy” with the following description of the procedure:
- There was an obvious palpable mass in the cecum, and I placed a stapler blue load across the terminal ileum in fired after appropriate pressure was held, also across the mid ascending colon at fired the stapler after appropriate pressure was held. We placed the terminal ileum to the side of the distal ascending colon and used a linear blue load with a limb of the stapler in each of the loops of bowel to anastomose the bowel together.
Question: How would you code this surgery?
- B300 Partial colectomy, removal of one or more segments with colon resection but less than half of colon is removed
- B400 Hemicolectomy (total right or left colon and a portion of the transverse colon)
- B800 Colectomy, NOS
Answer: B300 Partial colectomy
Rationale: STORE Appendix A and SEER Appendix C describe a partial colectomy as:
- B300 Partial colectomy, removal of one or more segments with colon resection but less than half of colon is removed
- Note: Code B300 includes removal of one or more colon segments, but less than half of the colon. Segments include cecum, ascending colon, hepatic flexure, transverse colon, splenic flexure, sigmoid colon, and/or the descending colon.
This surgeon stated the staple lines were created at the terminal ileum and mid-ascending colon with the anastomosis between the terminal ileum to the distal ascending colon. Since there was no indication of the hepatic flexure or transverse colon being resected this was a partial colectomy of a portion of the ascending colon.
