Wiki Help with coding Sm.Bowel Resect/Lysis of ad

[Hopp]

My Doc was first asst on an Ex.laparotomy,Sm Bowel Resect and Lysis of adhesions. Diag:560.81
I asked the attending for CPT codes and was sent the following: 44120 along with 44005-59. I believe that 44005 is bundled and cannot be billed without a 22 modifier and supporting documentation. Please help
Thank you
Deb, CPC

 

[Treetoad]

Usually, lysis of adhesions would be bundled into the main procedure. Depending upon the documentation (did the surgeon spend excessive time lysing adhesion before he could get to the small bowel?) you may be able to add modifier 22 to the main procedure and adjust your fee (higher) to compensate for the additional work involved. But the circumstances need to be documented within the OP note. Some insurances may pay for the additional effort involved.

 

[crhunt78]

My Doc was first asst on an Ex.laparotomy,Sm Bowel Resect and Lysis of adhesions. Diag:560.81
I asked the attending for CPT codes and was sent the following: 44120 along with 44005-59. I believe that 44005 is bundled and cannot be billed without a 22 modifier and supporting documentation. Please help
Thank you
Deb, CPC

That's right, the lysis of adhesions is bundled and the 44120 can be billed with a 22 modifier but since your doc was only the assist, you can only bill for what the primary surgeon is billing for at 25% of their fees. I would call the coder at the primary surgeon's office (unless its another surgeon in your practice) and talk to them. If that doesn't work, have your office manager or your surgeon call the other surgeon and explain the situation. I would only bill for the 44120 though.