# Laparotomy with massive lysis adhesions/correct small bowel volvulus



## Trendale (May 18, 2009)

Hello,

Can someone tell me the correct way to code the following:

The physcian converted from a lap to open laparotomy with massive lysis of adhesions and correction or repair of small bowel volvulus. Approximately 90% of the case was spent lysisng adhesions which was about 1 hour just lysing the adhesions. One adhesions has caused the bowel to twist and cause the volvulus causing an almost complete obstruction. Because of the adhesions, it was impossible for us to do this laparoscopically and we converted to open.
An hour ws spent lysing the adhesions so we can liberate the small intestines. In the mid jejunum, we noticed a twisting of the intetines consistent with a volvulus. We lysed adhesions and were able to turn the intestines and correct the volvulus. We now continued lysing the adhesions until we came down to the area of the pelvis. A loop of terminal ileum was stuck down in the pelvis with adhesions and sharp dissection was used to liberate this part of the intestines

He spent more than (90%,1hr) the usual time lysisng the adhesions, so I thought I could charge for that with a modifier 22 attached. Also I thought I can charge for he correction of the volvus (44050), but I am not sure which one to list as the primary procedure. there is a CCI edit that bundles 44005 into 44050. Can this be unbundled with a modifier 59? Or should I just bill the 44050 only?

This is what I have, not sure if it is correct. Pleae let me know.

44050
44005-59-51-22
DX's 560.9  V64.41
Thanks!


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## Zina (May 26, 2009)

Even though these services are bundled, I think you can bill both codes but this will become an appeal situation. The 44005 has more RVU's than the 44050 but I would make 44050 the primary procedure. I would use dx: 560.2 and 560.81 with the V64.41 I would not use the -59 modifier, only the -51 and -22. You will have to include the operative report and a letter of explanation as to why you are unbundling (eg. the excessive amount of time spent lysing the adhesions). If you can, inlcude the amount of time it would usually take to correct a volvulous if the adhesions were minimal. Also ask the surgeon if he performed a Ladd procedure, this would be code 44055 which would replace both of these codes. Hope this helps. Adhesions are tricky. Anyone else's input would be appreciated!


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## magnolia1 (May 26, 2009)

Per the CMS NCCI edits for physicians, these two codes cannot be unbundled with a modifier.
I would use 44050 only.


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## FTessaBartels (May 26, 2009)

*44050-22*

I'd use 44050 with -22 modifier (due to extensive lysis of adhesions)

F Tessa Bartels, CPC, CEMC


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