# Billing CPT codes 44180 and 44950 together



## jwbcoder (Aug 11, 2017)

I have a question regarding billing CPT codes 44180 and 44950 together.  I have seen in the past that if you bill CPT code 44180 (laparoscopy, surgical, enterolysis) with any other surgical code it will bundle.  I have checked the CCI edits and I cannot find anything that shows that these codes bundle.  If anyone has any suggestions about this I would greatly appreciate it.


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## CodingKing (Aug 11, 2017)

According to the NCCI Manual



> Open enterolysis (CPT code 44005) and laparoscopic enterolysis (CPT code 44180) are defined by the CPT Manual as “separate procedures”. They are not separately reportable with other intra-abdominal or pelvic procedures. However, if a provider performs an extensive and time-consuming enterolysis in conjunction with another intra-abdominal or pelvic procedure, the provider may append modifier 22 to the CPT code describing the latter procedure. The local carrier (A/B MAC processing practitioner service claims) will determine whether additional payment is appropriate.



In general any CPT that is designated "Separate Procedure" is bundled when it is performed at the same patient encounter as another procedure in an anatomically related area through the same skin incision, orifice, or surgical approach.

You aren't seeing the edit is 44950 is an open procedure and 44180 is a Laparoscopic procedure so its a different surgical approach. If laparoscopic appendectomy was done the correct code is 44970 not 44950 and does bundle.


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## jwbcoder (Aug 14, 2017)

The patient did have an open appendectomy.  Does this change the situation since it was not done laparoscopically?


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## CodingKing (Aug 14, 2017)

It depends on why it was done open. Say it started as laparoscopic removal, adhesions caused the need to convert to open then no cannot bill a dx/sx scope.

NCCI Manual: 



> If a laparoscopic procedure is converted to an open procedure, only the open procedure may be reported. Neither a surgical laparoscopy nor a diagnostic laparoscopy code should be reported with the open procedure code when a laparoscopic procedure is converted to an open procedure.


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## sequester25@gmail.com (Aug 14, 2017)

Wouldn't you want to add DX: Z53.31 as the last to indicate the conversion?


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## jwbcoder (Aug 15, 2017)

Ok thank you for your help!


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