Health data standards and systems

Mitrofanoff appendicovesicostomy creates a channel into the bladder through which a catheter can be inserted to empty the bladder. The procedure attaches the appendix between the skin and the bladder in order to provide an outlet for urine – one end is tunneled into the bladder and the other end is made into a stoma.

ACHI contains procedure codes for the formation of the mitrofanoff 37045-00 [1108] and revision of mitrofanoff 36609-00 [1087]. We have patients who are admitted for closure of mitrofanoff and we are unsure what is the best way to code them. We have been coding to;

Closure
-stoma
--intestine NEC
--- large 30562-05 [917]

We chose this to reflect the complete closure of the stoma, however it doesn’t reflect the urinary aspect of the mitrofanoff. Or does 36609-00 [1087] Revision of intestinal urinary conduit cover both revision and closure of a mitrofanoff?

If we code a Z43.x code to reflect the attention to, do we code to Z43.4 Attention to other artificial openings of digestive tract OR Z43.6 Attention to other artificial openings of urinary tract? As the mitrofanoff is used to drain the urinary system, however it’s location & opening is through a portion of the intestinal tract.

This query was originally published in September 20006 and previously retired on 30 June 2010. It was reinstated effective 1 July 2020 following a review as the advice is considered current.

The VICC advises that this procedure is a closure of the external opening of the bladder and that the appendix is the material that has been used to create the opening. Therefore, following the index entries Closure, vesicotomy or Closure, cystotomy the correct procedure code to assign is:
37023-01 [1105] Closure of cutaneous vesical fistula

For patients who are admitted for closure of mitrofanoff, the correct diagnosis code to assign is:
Z43.6 Attention to other artificial openings of urinary tract