Wiki 50715 ureterolysis with extensive removal of bowel adhesions

[JDuhaime]

I have a provider who would like to bill for extensive removal of bowel adhedisons while performing ureterolysis. She is trying to use an unlisted however I am suggesting modifier 22 on 50715 as documentation does support modifier 22. The work was extensive and she thinks it should be billable. I am rather new to OBGYN and could use some guidance. I know that most of the time adhesions are not reimbursed separately. She performed one panel of the surgery with other providers.

Due to the extensive amount of adhesions from the bowel requiring at least 1 hour of adhesiolysis just to get the Bookwalter on, and then many hours of adhesiolysis to get the mass out, this case took at least 9% longer than usual.

 

[csperoni]

It would be helpful to know what other codes this provider is billing for. You also indicate there were "other providers" but not whether they are the same specialty and/or part of the same group.
Additionally, 50715 is ureterolysis for RETROPERITONEAL FIBROSIS. If retroperitoneal fibrosis (Ormond's disease) is not documented, then 50715 would be incorrect.
If 50715 is the accurate code, you should determine what potential codes to use for lysis of bowel adhesions and check if they are NCCI edits.

 

[JDuhaime]

Thank you, 50715 is being used for retroperitoneal fibrosis per documentation, The codes for removal of adhesions do have edits, modifier not allowed. After further discussion, She also removed a ovarian remnant, patient had a BSO already in 2023 so she did not think she could bill for it. Path states ovary with benign serous cyst, we are reviewing to find if there is an appropriate code for this. It is looking like modifier 22 is the best option for the adhesions.