General Surgery Coding Alert

Hint: Check for complications, open procedures Although reporting cholecystectomy is usually straightforward, you might be missing circumstances that warrant additional payment. If you are able to recognize such circumstances (such as unusually complicated surgeries or laparascopic-to-open conversions), our experts say, you can make the most of your coding and ensure the surgeon gets the reimbursement he or she deserves for the work performed. Call on Modifier -22 for Unusually Difficult Procedures On occasion, the surgeon will encounter unusual difficulties when performing a cholecystectomy. This can occur, for example, if the surgeon must
  perform extensive lysis of adhesions;
  remove gall stones or deal with another complication; or
  convert from a laparoscopic to an open procedure. Although a surgeon generally may not bill additional codes for complications during surgery, he may access modifier -22 (Unusual procedural services) to gain additional payment.
 
"If a surgery requires significant additional time or effort that falls outside the range of services described by a particular CPT code, that's the time to apply modifier -22," says Barbara J. Cobuzzi, CPC, CPC-H, MBA, president of Cash Flow Solutions Inc., a Lakewood, N.J., billing company.
 
For example, during laparoscopic chole-cystectomy (lap chole), the surgeon must lyse extensive adhesions. In this case, the surgeon may not claim 44200 (Laparoscopy, surgical; enterolysis [freeing of intestinal adhesion] [separate procedure]) in addition to the lap chole because the National Correct Coding Initiative (NCCI) bundles the procedures. But if the surgeon spent significant additional time lysing adhesions (in other words, if the adhesions added at least 25 percent additional time or effort beyond that typically required for a lap chole), you may report the appropriate lap chole code with modifier -22 attached. 
 
In a second example, during a routine laparoscopic gallbladder surgery (lap chole), the surgeon finds that there are a few stones in the patient's common duct that take an additional two hours to remove through the scope. There are no extra codes to report in this case, so you would append modifier -22 to 47564 (... cholecystectomy with exploration of common duct), says Terry Fletcher, BS, CPC, CCS-P, CCS, CMSCS, CMC, a coding and reimbursement specialist in Laguna Niguel, Calif. Only Report Open Procedure for Conversions When a surgeon converts a lap chole to an open procedure, CMS and CPT coding guidelines dictate that you may report the open procedure only. Just as in the above scenarios, however, if the surgeon spends considerable additional time or effort performing a laparoscopic procedure before converting to an open procedure, you may append modifier -22 to the open procedure code.
 
Note that modifier -22 is not warranted for all conversions: To gain additional payment, the surgeon's documentation must firmly establish why the additional effort was necessary.
 
For example, [...]