Urology Coding Alert

Question: Our physician spent about 40 minutes removing adhesions so the patient’s laparoscopic prostatectomy port could be placed. Can we bill anything for this?

Nebraska Subscriber

Answer: You should report the procedure itself with 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed). Before adding another code to the claim, however, understand that everyone has adhesions, and there is an expectation that the surgeons will lyse them when they’re encountered during surgery. That means you cannot report a separate procedure code for the lysis.

When the adhesions are dense due to previous surgeries or chronic disease, or when the surgeon removes significant amounts of scarring or adhesions, you might be able to append modifier 22 (Increased procedural service). CPT^® does not provide specific direction as to the amount of time and/or percentage increase of time or work required to compliantly report modifier 22. But the general rule of thumb is that the surgeon must spend at least 50 percent more time and/or put in at least 50 percent more effort than normal for you to append modifier 22. You should have clear documentation of at least a 50 percent increase in work and/or time to justify using modifier 22.