Wiki Adhesions: CCI vs CPT Assistant

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lorrpb

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Laparoscopic appendectomy converted to open d/t extensive adhesions. 44950 and 44005.

Encoder says: Code 44950 is a column 2 code for 44005, These codes cannot be billed together in any circumstances. Code 44950 is bundled into code 44005. (I understand this.)

If I use 44005 with dx 540.1, encoder returns: Diagnosis code may not match/support the procedure. (This is what I would expect.)

Here's the kicker:
CPT ASSISTANT says that 44005 CAN be used with intestinal CPT codes:

January 2000; Volume 10: Issue 1
January 2000 page 11

Coding Consultation
Digestive System, Surgery, Intestines (Except Rectum), 44005 (Q&A)
Question
Is it appropriate to ever report code 44005 with the other intestine codes?
If so, under what circumstances?

AMA Comment
From a CPT coding perspective there are some instances when you could report code 44005 with other intestine codes. In the instance where dense, extensive adhesions require significantly greater physician work and procedural complexity, it would be appropriate to report code 44005-59 in addition to the intestinal surgery procedure. The physician would need to document these circumstances in the operative report.

This does not make sense. Has this edit changed since the CPT Asst article in 2000?

I really can't convince myself to go against the NCCI edit. Do I just use 44950-22?
Thanks.
 
CPT vs NCCI

Ah, this is the thorn that never dies. LOL You must remember NCCI although it's name says Correct Coding is really about billing and not strictly about coding. There are many instances where under the coding guidance by CPT/AMA you are allowed and (in a pure coding world) you should code appropriately for what was done. But alas, this doesn't mean it can be billed.
Certainly you could try to argue it with the payer but the path of least resistance and quicker reimbursement and still a correct coding methodology would be as you suggested, which was to add modifier 22 and then support it with the documentation and request for increased payment.

Sorry for the verbose answer I just couldn't resist touching on this dilemma that never goes away. :)
 
In this case it was just the scopic procedure has been converted to open, this documentation alone does not justify the procedure 44005. The surgeon must removed the extensive adhesions after converting the scopic into open procedure. Further the usual removal of adhesions is inclusive to the surgical package of the original surgical procedure. The remove adhesions must be extensive and and time consuming for the sergeon when compared to the usual appendectomy procedure. In the instance where dense, extensive adhesions require significantly greater physician work and procedural complexity, it would be appropriate to report code 44950 with modifier 22. In turn mod 22 will increase the payment upto 18% which in turn justify the surgeon's additional work.

Thanks,
M. Sivakumar CPC, CPC-H
 
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