# Intraoperative consult/lysis of SB adhesions



## rsboggs (May 29, 2012)

Our GS was called into an already open case by an OB/GYN performing a diagnostic lap on a lady for chronic pelvic pain. The OB/GYN encountered extensive abdominal and small bowel adhesions. 

My GS performed adhesiolysis using harmonic scalpel and blunt dissection of the small bowel adhesions and adhesions around the umbilicus taking approx. 15 minutes. He did not open, close or insert any additional ports. 

At a coding seminar I attended we were told that if the surgeon "looks only", just bill the E&M code no procedure. If he actually does something to the patient, bill the "procedure he performed" only with a modifier 52 since no opening or closing was performed. 

So in the past I would bill a 44180/52 with notes attached. I am second guessing myself now though as I am reading posts here that state we bill the primary procedure with a 62 mod. 

Another example is my GS is called in by the OB/GYN for an appy during a diagnostic lap/hyster etc. I have been billing those as 44970/52.

Any help or input would be greatly appreciated.


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## Lujanwj (May 30, 2012)

I'm not sure I would use -52 at all in these cases (unless dr is planning on closing or finishing on a later date).  NCCI or CPT doesn't address that you must open or close; however, NCCI standard of care rules should be applied.  If the dr met the standard of care in that situation I'd code it with no modifiers.  

Lysing is going to be a different problem.  The main issue is billing for it when another procedure is done as lysis will be bundled (unless there is a different DX at a different surgical site).  If you dr is going in and assisting with lysing for another procedure, it is just that, an assistant -80(see guidelines for -80 vs -62).  I'm aware that the Drs are different specialties and bundling rules don't apply but in cases of lysing you can't get around it.  If this was billable, GS' would be waiting on standby just do lysis for other specialties so they can unbundle an incidental procedure.  With that being said, if you dr went in during a bladder procedure and did lysis for a small bowel obstruction I'd bill for that.  Medical necessity will have been met and you will have a different DX from bladder repair.  

This is only my interpretation.  Unfortunately, I don't have any documentation from CMS or AMA confirming or contradicting. If someone finds some docs please attach in response, it'd be greatly appreciated.


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