General Surgery Coding Alert

Question: During laparoscopic cholecystectomy, the surgeon encountered extensive adhesions. Can we report lysis of adhesions separately using 44200?


Pennsylvania Subscriber
Answer: No, you cannot claim 44200 (Laparoscopy, surgical; enterolysis [freeing of intestinal adhesion] [separate procedure]) in addition to the lap chole (such as 47562, Laparoscopy, surgical; cholecystectomy) because the National Correct Coding Initiative bundles the procedures. And the use of "separate procedure" in the descriptor for 44200 means that you can only report lysis of adhesions separately if it is the only procedure the surgeon performs.

If, however, the surgeon spent significant additional time lysing adhesions (in other words, if the adhesions added at least 25 percent additional time or effort beyond that typically required for a lap chole), you may report the appropriate lap chole code with modifier 22 (Unusual procedural services) attached.

Be sure to include a cover letter describing the unusual nature of the procedure, as well as a request for additional compensation. Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, HIM program coordinator at Clarkson College in Omaha, Neb.