General Surgery Coding Alert

Question: How should we report an exploratory laparotomy, lysis of adhesions and decompression of small bowel obstruction for a patient with an incomplete small bowel obstruction secondary to adhesions? Missouri Subscriber Answer: A patient may develop adhesions due to surgery, radiation, blunt trauma or infection, among other reasons. Because the organs in the abdominal region are in close proximity, the adhesions can cause the small bowel to adhere to itself or other organs, which can cause an obstruction (560.81, Other specified intestinal obstruction; intestinal or peritoneal adhesions with obstruction [postoperative] [postinfection]). The appropriate code for lysis of abdominal adhesions is 44005 (Enterolysis [freeing of intestinal adhesion] [separate procedure]). The national Correct Coding Initiative (CCI) bundles the exploratory laparotomy (49000) to 44005, and you may not report it separately. Note: Given the diagnosis of incomplete small bowel obstruction secondary to adhesions which means the adhesions caused the small bowel obstruction 58740 (Lysis of adhesions [salpingolysis, ovariolysis]) is not applicable because it involves lysing adhesions from a different location. You do not mention if the surgeon used a separate method to resolve the bowel obstruction. Note, however, that if tube placement or resection were performed the lysis of adhesions and laparotomy will likely be bundled to it. Specifically, CCI does not allow for separate billing of 44005 or 49000 with tube placement (44021, Enterotomy, small intestine, other than duodenum; for decompression [e.g., Baker tube]). In this case, if lysis of adhesions requires significant physician work or time beyond that normally expected, 44021 may be reported with modifier -22 (Unusual procedural services) to gain additional reimbursement. Be sure to include a detailed operative report and a request for adjusted payment commensurate with the extra effort required.