Wiki 44180

[nlbarnes]

My doc performed appy (44970) w/ lysis of adhesions (44180). 44180 is bundled w/44970. She wants me to bill 44180 since it's a higher RVU. I know that is not how it's done. I've done this a thousand times (billing the appy) but I'm goint to need backup for this to present.

Is it simply that the descriptor for 44180 states (separate procedure)? And if so, will someone please elaborate on that.

Or, if it's something else, provide that documentation, as I mentioned, I'm going to need it.

Thanks...

 

[CodingKing]

NCCI Manual is the best place to reference

CHAPTER VI.E.8

Open enterolysis (CPT code 44005) and laparoscopic enterolysis (CPT code 44180) are defined by the CPT Manual as “separate procedures”. They are not separately reportable with other intra-abdominal or pelvic procedures. However, if a provider performs an extensive and time-consuming enterolysis in conjunction with another intra-abdominal or pelvic procedure, the provider may append modifier 22 to the CPT code describing the latter procedure. The local carrier (A/B MAC processing practitioner service claims) will determine whether additional payment is appropriate.

Also the provider cannot chose omit a code to to increase reimbursement. Misreporting the procedure done is a violation of several regulations including the Federal False Claims Act.

 

[nlbarnes]

Thank you. I am aware of the guidelines from coding the last 7 years. I wanted something other than the guidlines. We got it worked out. Thank you!

 

[CodingKing]

Good to see its resolved. I'm not sure why the official guidelines would not have been be sufficient. Were they looking for unofficial guidelines?