Lysis of adhesions reimbursement and bilateral mastectomy coding

[nannie23]

Any suggestions of obtaining reimbursement for cpt 44005 when performed for 30 minutes or more with other procedure. I usually append modifier 22 but medicare doesnt want to reimburse

 

[cgaston]

The NCCI edits are clear that 44005 is not separately reportable with other procedures.

I think the problem might be that Medicare does not consider 30 minutes "an extensive and time consuming enterolysis".

Our company's policy is that we add the -22 if lysis is 90 minutes and above.

 

[csperoni]

For use of -22 to primary procedure for lysis of adhesions, I have seen varying advice regarding the time required. Most advice is for 60+ minutes, but I have seen for as little as 30 minutes.
In our cases, we use 30 minutes of lysis as the threshold for -22. Most insurances require the operative report and letter with modifier 22. The letter is a fairly standard form letter where we request additional 20% payment for 30 minutes; additional 30% for 45 minutes; additional 40% for 60 minutes. If you don't have a contract that specifies what additional payment is for a justified -22, insurances will generally review on a case by case basis. The insurance may have determined that (in their opinion, or by their policy) 30 minutes does not justify any additional payment. If the insurance denied my -22 request, I would only take it further for a minimum of 60 minutes.
Good luck,