Ob-Gyn Coding Alert

Question: We have a physician who performed a 44180 (Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)). During the procedure, another physician performed a 44970 (Laparoscopy, surgical, appendectomy), and our physician assisted. I billed a 44180 and then 44970-80, but the insurance company bundled them together. I want to appeal it, but now I’m thinking maybe I should have used a modifier. Is that so?

Florida Subscriber

Answer: Unfortunately, these two codes are always bundled whether the surgeon is acting as the primary for this combination or as an assistant for one of the procedures. The bundling edit does not allow for a modifier to bypass the edit (e.g. modifier 59, Distinct procedure). Even the newer “X” modifiers which are meant to replace modifier 59 would not be allowed with this code combination due to this being a permanent edit (with an indicator of “0”). For instance, XP (Separate Practitioner), would still not be allowed with this code combination. You can appeal, but the chances of winning are slim given the current bundling edit assignment. However, if your physician did not bill at all for assisting and only billed 44180, that would probably be reimbursed.