# need help with internal hernia coding



## bmyers (Feb 9, 2015)

Please read the following op report. Not sure if I should just code the lysis of adhesions or can I code the internal hernia due to adhesions?  44005 or would the 44050 be used. 
Here is op report:
Post op procedure:  Laparotomy, Lysis of adhesions.  

NDICATIONS:  A 76-year-old female has a nonresolving SBO.

FINDINGS:  Small-bowel obstruction, internal hernia with small bowel through the opening in the omentum.

DETAILS OF PROCEDURE:  The patient was identified preoperatively and consent had been obtained.  A midline incision was made after performing a timeout, placing Foley catheter.  Peritoneal cavity was entered.  There was a piece of omentum with a small hole in it and a loop of bowel through it.  On opening up that area of the omentum by dividing the tissue bridge, it was clear that those were the 2 points [*] obstruction.  The remaining bowel was run proximally and distally and was perfectly normal.  There were no any other significant findings intraabdominally.  The omentum was then brought down over the small bowel completely.  There was one other omental adhesion to the pelvis that was divided and then the fascia was closed with figure-of-eight #1 PDS sutures and the skin with skin staples.  No drains used.  The patient tolerated the procedure well and was taken to recovery in satisfactory condition and at the end of the case, sponge, needle and instrument counts were all reported to be correct.


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## cynthiabrown (Feb 9, 2015)

44050


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## kleise (Feb 17, 2015)

*internal hernia*

Cynthia, I dont know if this will help.  I code on the physician side.  You cannot use 44050 and 44005 together.  44005 is part of 44050.  When I read your op report, it does not look like much adhesions, so only the diagnosis code.  If the physician takes a great amount of time and documents that, 
I put modifier 22 on the claim.  The insurance company will always ask for the notes.  Hope this helps.


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## cynthiabrown (Feb 17, 2015)

it wasn't my question  I said only bill for internal hernia  I know LOA included.......need time.risk,difficulty involved to bill 22 mod


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