General Surgery Coding Alert

Question: One of our surgeons recently admitted a patient with an incomplete small bowel obstruction secondary to adhesions. The surgeon performed an exploratory laparotomy, lysis of adhesions and decompression of small bowel obstruction. How would this be coded?

Arkansas Subscriber

Answer: A patient may develop adhesions resulting from surgery, radiation, blunt trauma or infection. Because the organs in the abdominal region are tightly packed, the adhesions can cause the small bowel to adhere to itself or other organs, which in turn can cause an obstruction (560.81, other specified intestinal obstruction; intestinal or peritoneal adhesions with obstruction [postoperative] [postinfection]).

Given the diagnosis of incomplete small bowel obstruction secondary to adhesions meaning the adhesions caused the small bowel obstruction 58740 (lysis of adhesions [salpingolysis, ovariolysis]) is not likely correct, because this procedure involves lysing adhesions from a completely different part of the anatomy, says Elaine Elliott, CPC, practice coder with Treasure Coast Surgical Group, an eight-physician practice in Stuart, Fla.

The correct code for lysis of abdominal adhesions is 44005 (enterolysis [freeing of intestinal adhesion] [separate procedure]), but this procedure is bundled with 44021 (enterotomy, small bowel, other than duodenum; for decompression [e.g., Baker tube]). Therefore, the only procedure that may be billed is 44021, because both the lysis of adhesions and the exploratory laparotomy (49000) are bundled with this procedure.