General Surgery Coding Alert

Question: The surgeon performed an open partial colectomy with anastomosis. During the procedure, the surgeon documented take-down of extensive adhesions from previous surgeries, spending an hour and 10 minutes lysing adhesions before accessing and resolving the colectomy. Can we code for this extensive enterolysis using a code such as 44005?

Tennessee Subscriber

Answer: No, you should not bill 44005 (Enterolysis [freeing of intestinal adhesion] [separate procedure]) in addition to the appropriate code for the case, 44140 (Colectomy, partial; with anastomosis).

Similarly, if the procedure had been laparoscopic, the correct code would be 44204 (Laparoscopy, surgical; colectomy, partial, with anastomosis) without the additional code 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]) for the lysis of adhesions.

Here's why: Both 44005 and 44180 are listed as "separate procedure" codes, which means that the service described by the code is integral to any other surgery performed at the same anatomic site on the same date. Therefore, the reimbursement for enterolysis is built into abdominal procedure pay.

Option: If your surgeon documents the extra work involved in the enterolysis, you might consider filing the surgical code with modifier 22 (Increased procedural service) to see if you can earn extra pay. Reporting the code with this modifier will require that you attach documentation of the extra work, and an estimate of expected additional pay based on your surgeon's work for the "typical" procedure.