General Surgery Coding Alert

Question: The surgeon performed an open limited lysis of adhesions in the abdominal cavity and a laparoscopic lysis of extensive pelvic and ovarian adhesions. How should we code this?

Codify Subscriber

Answer: You cannot bill together the codes for an open abdominal lysis of adhesions (44005, Enterolysis (freeing of intestinal adhesion) (separate procedure)) and a laparoscopic lysis of adhesions (58660, Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)).

Correct Coding Initiative (CCI) edits bundle code 44005 as a column 2 code with 58660 with a modifier indicator of "0," meaning that you cannot override the edit pair under any circumstances.

You should bill the most extensive code for your surgeon's work, which is 44005 ($1,142.27 national facility rate, 2018 Medicare Physician Fee Schedule, conversion factor 35.9996).

By comparison 58660 pays $687.23 (national facility rate, 2018 Medicare Physician Fee Schedule, conversion factor 35.9996).