General Surgery Coding Alert

Question: The surgeon performed an exploratory laparotomy with division of adhesive band and lysis of adhesions. He cited a diagnosis of 560.81 (Intestinal or peritoneal adhesions with obstruction [postoperative] [postinfection]). How would I report this? Illinois Subscriber Answer: The "adhesive band" is the specific adhesion causing the obstruction, and division of this adhesive band is an included part of an "open" lysis of adhesions as described by 44005 (Enterolysis [freeing of intestinal adhesion] [separate procedure]). Additionally, CMS and other payers bundle the exploratory laparotomy with the enterolysis (44005). Therefore, you would not separately bill for the exploratory laparotomy. Note, also, that 44005 is itself a designated "separate procedure." This means that had the surgeon performed another procedure in the same anatomical area during the same session (for example, an appendectomy), you would report only the major procedure and would not bill separately for the enteroloysis.