What is Serial Transverse Enteroplasty (STEP) and How is it Coded?
Serial transverse enteroplasty (STEP) is a surgical procedure that aims to lengthen the small intestine of children with short bowel syndrome. Short bowel syndrome is a condition where the small intestine is not functioning properly due to congenital defects, injury, or disease. Children with short bowel syndrome may have difficulty absorbing nutrients from food and may need parenteral nutrition (PN) through an intravenous (IV) line or enteral nutrition through a feeding tube.
STEP was developed by surgeons at Boston Children's Hospital in 2002 as an alternative to bowel transplantation. The procedure involves making alternating cuts along the small intestine and stapling the edges together to create a longer and narrower tube. This increases the surface area of the small intestine and improves its motility. STEP can help reduce the dependence on PN and improve the quality of life of children with short bowel syndrome.
According to the National Institute for Health and Care Excellence (NICE), STEP is a safe and effective procedure for bowel lengthening in PN-dependent children. However, it is not widely available and should only be performed by experienced surgeons in specialized centers. NICE also recommends that data on the outcomes of STEP should be collected and monitored in a national registry.
The coding of STEP varies depending on the classification system used. In SNOMED CT, which is a clinical terminology for recording clinical information, the preferred term for STEP is Serial transverse enteroplasty (840881000000106). In OPCS-4, which is a classification system for aggregating and analyzing data, the most suitable codes for STEP are G78.8 Other specified other open operations on ileum and Y26.3 Stapling of organ NOC. In ICD-10-AM, which is another classification system for morbidity coding, the best fit code for STEP is 90307-00  Other procedures on small intestine.
Serial Transverse Enteroplasty Procedure (STEP) | Boston Children's Hospital
Serial transverse enteroplasty procedure (STEP) for bowel lengthening in parenteral nutrition-dependent children | NICE
SUBJECT: Serial transverse enteroplasty procedure (STEP) | Safer Care Victoria
How is STEP performed?
STEP is performed under general anesthesia and usually takes about two to three hours. The surgeon makes an incision in the abdomen and exposes the small intestine. The surgeon then measures the length of the small intestine and decides how many cuts to make. The surgeon makes a series of V-shaped cuts along the small intestine, alternating the direction of the cuts. The surgeon then staples the edges of the cuts together, creating a longer and narrower tube. The surgeon checks the blood supply and function of the small intestine and closes the incision.
What are the benefits and risks of STEP?
STEP can help children with short bowel syndrome to increase their intestinal absorption and reduce their need for PN. This can improve their growth, development, and quality of life. STEP can also prevent or delay the complications of PN, such as liver damage, infections, and catheter problems. Some children may be able to wean off PN completely after STEP.
However, STEP also has some risks and limitations. The procedure is technically challenging and requires specialized skills and equipment. The procedure may not be suitable for all children with short bowel syndrome, depending on the cause and severity of their condition. The procedure may not achieve enough bowel lengthening for some children to wean off PN. The procedure may cause complications such as bleeding, infection, bowel obstruction, perforation, or leakage. The long-term outcomes and effects of STEP are still uncertain and need further research. aa16f39245