# lysis of adhesions during an intraoperative consult



## mbdonn (Jan 24, 2012)

I am hoping someone can help me....
my surgeon was called in during a hysterectomy due to extensive adhesions from the posterior uterine wall and cervix to the termianl ileum and the sigmoid colon.  Op note states "we placed the retractor that was then placed by using a Bookwalter retractor to acheive better exposure.  We packed all the bowel cephalad and then started our mobilization in the posterior wall of the uterus on th right, identified the cecum and terminal ileum which were seperated by  dividing the line of Toldt and the completely mobilized in its cephalad on the left side, we identified the left adnexa and ovary and seprated it from the sigmoid colon by the ligasure and sharp dissection using the Bovie, we separated the sigmoid colon and rectum all the way down to the posterior cervical os.  They packed everything and left it exposed for the other Dr. to finish their part.  

I am at a loss.  I came up with 44005-62 but somehow do not think that is correct.  Please help.  Thanks!


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## Lujanwj (Jan 26, 2012)

You'd use mod -62 on the hysterectomy.  Since lysis would be bundled into the definitive procedure you can not unbundle it.  

Sounds like Dr performed a distinct part of the procedure - Approach.  See guidelines for Mod -62 in Appedix A.   

Good Luck!


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## colorectal surgeon (Jan 27, 2012)

I would just code this as 44005.  That's what he did.  If the gyn did the lysis of adhesions for the hysterectomy then it can't be coded. But can't the surgeon who was called in for the lysis of adhesions code for this?


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## FTessaBartels (Jan 31, 2012)

*Hysterectomy w/ 62 modifier*



colorectal surgeon said:


> I would just code this as 44005.  That's what he did.  If the gyn did the lysis of adhesions for the hysterectomy then it can't be coded. But can't the surgeon who was called in for the lysis of adhesions code for this?



I think each surgeon would use the SAME primary code (whichever hysterectomy code is appropriate) with a -62 modifier.  

It's similar to when a general surgeon opens/closes for an Orthopaedic or Neurosurgeon who performs the anterior arthrodesis.  They are each performing a "unique" service, which is a part of a whole.  

NOTE - if the enterolysis was extensive (i.e. took more than an hour), I would also add a -22 modifier to the hysterectomy code. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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