Wiki Lysis of adhesion and enterostomy

[amanda19791]

Need some advice on the following procedure below. My provider want know if he could bill lysis of adhesion and enterostomy. Codes used 44620, 44180 & 44005. Thanks advance.


ICD-10:

* Bowel perforation (HCC) [K63.1]
* Altered bowel elimination due to intestinal ostomy (HCC) [K94.19]
* Prematurity, 500-749 grams, 25-26 completed weeks [P07.02]
* NEC (necrotizing enterocolitis) (HCC) [K55.30]


Procedure:

Incision was made around the ostomies and slightly extended on each lateral aspect. 　Electrocautery was used to extend the incision through the layers of the abdominal wall. 　The peritoneal　cavity was entered and careful dissection was used to circumferentially dissect around all of the ostomies. 　The skin bridge between the ostomies was divided and each pair of ostomies was dissected until it was free of surrounding adhesions.
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There were dense adhesions diffusely in the abdomen. 　In particular, there were dense adhesions from the ostomies to the inferior edge of the liver. 　There were diffuse adhesions between loops of bowel and colon. 　We performed a lysis of adhesions that lasted approximately 1 hour. 　Once the bowel was completely freed of adhesions and able to be mobilized and evaluated we measured the bowel. 　We inspected to see if there is any sign of stricture and did not find any. 　We then chose the location to divide the proximal to ostomies to create the proximal anastomosis. 　The mesentery was divided between them with electrocautery. 　The bowel was divided sharply. 　Hemostasis was maintained with electrocautery. 　A handsewn, end to end anastomosis was created using 5-0 Vicryl. 　This procedure was repeated for the second, more distal ostomy. 　The only difference was that the mesentery was divided between ligatures. 　Before the second anastomosis was complete we inserted a Robnell catheter in the distal limb and irrigated until we saw distention of the remaining small bowel, colon, rectum, and had evidence of evacuation of colonic contents per rectum. 　We then completed the second anastomosis. 　We irrigated the abdomen with warm saline. 　We return the bowel to its normal anatomic location. 　We closed the fascia in layers using 3-0 PDS in the anterior posterior rectus sheath. 　We closed Scarpa's with interrupted 4-0 Vicryl. 　Closed the skin with interrupted 5-0 Monocryl. 　A vessel loop was laid on top of the fascia prior to closing Scarpa's and skin. 　The vessel loop was then moved onto itself and secured. 　Skin was cleaned and dried and the incision was covered with an OpSite dressing.

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[CodingKing]

If you run this through NCCI edits only 44620 is allowable. The other 2 codes are bundled and not eligible to be bypassed with modifiers.
Doc will want to consider adding modifier -22 to account for the 1 hour to deal with dense adhesions. payer may or may not allow extra once they review the notes.

 

[dawn7777]

I am confused by this note. You cannot bill both a lap code with an open code in the same setting. what is the original surgery? takedown of ostomies?