General Surgery Coding Alert

Question: How should we code this open procedure, when the general surgeon performs a sigmoid colon resection and a urologist performs a ureteral stricture repair during the same surgery:

·         Laparotomy

·         Lysis of adhesions

·         Rigid sigmoidoscopy and sigmoid colon resection with loop ileostomy and mucofistula

·         Repair of colo-vesical fistula

·         Cystoscopy, dilation of ureteral stricture and repair

Tennessee Subscriber

Answer: The general surgeon and the urologist appear to be co-surgeons on one service (44661, Closure of enterovesical fistula; with intestine and/or bladder resection), which you should bill for each surgeon using modifier 62 (Two surgeons).

For the general surgeon, you should additionally bill 44144 (Colectomy, partial; with resection, with colostomy or ileostomy and creation of mucofistula). The urologist additionally bills 52341 (Cystourethroscopy; with treatment of ureteral stricture (e.g., balloon dilation, laser, electrocautery, and incision).

You should not separately bill for the lysis of adhesions (44005, Enterolysis [freeing of intestinal adhesion] [separate procedure]). Medicare’s Correct Coding Initiative (CCI) edits list 44005 as a column 2 code with 44144, with a modifier indicator of “0,” meaning that you cannot override the edit pair under any circumstances.

If the surgeons carefully document significant additional work involved in lysing the adhesions, you may be able to increase payment by appending modifier 22 (Increased procedural services) to the appropriate code(s).

Caution: To ensure accurate coding, you’ll always need to code from the entire op report, not just an abbreviated procedure description such as this question.