# When to code for Lysis of Adhesions



## elora81 (Apr 10, 2014)

Hello All,

I was hoping you could shed some light on this dispute we are having. I can?t recall where I read this but I read that in order to code for Lysis of Adhesions the doctor must dictate that it was extensive and provide time spent of 60 minutes or more, some say 45 minutes or more. I am rebutting an audit and one of the suggestions made from that reviewer was to add a modifier 22 b/c the op report indicated extensive lysis of adhesions but there is no mention of time. Now since this is regarding my doctors I know that there are some that deserve the credit for performing extensive work b/c they document 1,2 even 3 hours? worth of just lysis of adhesions. Some providers cut for 20 minutes and they deem that as extensive when in fact it is just part of the approach.

Everything I look up now only states that the physician needs to dictate key phrases like: tedious lysis, extensive lysis, difficult, etc. but no mention on time spent.

I want to be able to give accurate feedback regarding my rebuttal and also give an accurate reference for the coders to follow when they see this scenario.

Any feedback would be greatly appreciated.


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## FTessaBartels (Apr 22, 2014)

*Separate Procedure*

If you look at most codes for lysis of adhesions (e.g. CPT 44005 or 44180) they are listed as *Separate Procedure*.

This means that you CANNOT code them UNLESS this is the ONLY thing you are doing.

We do append a -22 modifier to surgeries where the physician has documented "extensive lysis of adhesions, lasting XXX (hours, minutes, etc)"  Our cut off is 1 hour (60 minutes).    We feel we can easily defend this in an audit as adding significant additional work to the procedure. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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