# HELP NEEDED! Terminal Ileum Nodule removal



## AR2728 (Jan 2, 2013)

While performing an appy (after appendix was removed) the doctor documented the following 
"the small bowel was run prosimally for about 150 cm...firm whitish exophytic nodule just adjacnet to the mesentery on the wall of the iluem.  The nodule was therefore grasped, raised up and was resected with a very small patial thickness portion of the small bowel involving mostly just the serosal layer.  A very minimal portion of the outer muscle layer was trimmed with it with the lesion removed with grossly negative margins of 1-2mm.  Nodule sent path, subsequent serosal defect was closed with silk Lembert type sutures...."

I'm really unsure what CPT I would post for this procedure.  I would greatly appreciate some assistance!!!!


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## AR2728 (Jan 3, 2013)

Any takers out there?  I'm wondering now if this excision of nodule would be considered incidental to the appy and therefore not separately billable.  Any thoughts?


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## MCook (Jan 3, 2013)

My first thought was to apply a mod 22 since additional work was done but you are correct ... it does seem incidental.  It does not appear to have taken the physician much additional time to excise it.  You could try the 22 and let the insurance decide if additional payment is warranted.  They will review the notes with the modifier 22.  Sorry that I don't have a more specific answer for you but I am not aware of a CPT code specific to this scenerio.


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## AR2728 (Jan 7, 2013)

Thanks for the reply-the feedback certainly helps!


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