# Documenation for Lysis adhesions



## dmaguire (Aug 1, 2011)

I am currently in a dialoge with a provider in my office regarding billing for extensive lysis of adehesions with a Roux-en Y and Hernia repair.  All coding documenation I have found states that its included in the procedure.  However, if documenation supports the extensive lysis of the addehsions you can bill with a modifier 22.  

Can you tell me how the documentation should read for the extensive Lysis of adhesions?  One of his dicated notes states:  The adbdomen was surveryed for trocar injuries.  None was appreciated.  Second trocare was placed under laparoscopic control which was inferior along the left lateral sidewall.  Through this troacar, a ligasure was placed, _and the adhesions from the omentum to the anterior abdominal wall were taken down.  This was done quite carefully, and the patient had additional omental adhesions to the area of an appendectomy scar.  These were also taken down.  Patient had some small intestine adhered to the anterior abdominal wall.  This was left in situ.  Taking down the adhesions required about 25 minutes of operative time._  Once the adhesions were taken down, 4 other trocars were introduced under laparscopic control.

Trying to bill compliantly 
Danielle


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## jackson7591 (Aug 1, 2011)

*reference*

http://www.isms.org/affiliates/PracticeManagers/Documents/coding_with_modifiers.pdf

you are correct in that lysis is bundled.  However, the above resource suggests that "average amount of lysis" is bundled, p-19.  Page 20 describes the various levels of time associated with "excessive" lysis, suggesting that the amount of additional time, in percent, would be the determining factor regarding using modifier 22 appropriately.


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## dmaguire (Aug 2, 2011)

Thank you.  We are still in converstations but you were able to give me information to bring to the table.  Now we are debating the fact that there is no specific CPT code for lysis of adhesions (extensive) for the type of procedures we perform.

Danielle


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## FTessaBartels (Aug 3, 2011)

*"Extensive" lysis of adhesions*

We ask our surgeons to specifically use the term "extensive lysis of adhesions" and to indicate the amount of time spent on this before being able to procede with the primary procedure.  If the time spent on LoA is 1 hr or more then we add the -22 modifier. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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