Wiki Lysis of adhesions

[kimberliterpstra]

Has anyone ever been paid for this procedure when billing it with another abdominal procedure? Our claims scrubber won't even allow us to charge it when we charge another abdominal procedure.
However, my providers are frustrated that they can sometimes spend 2-5 hours on an extensive lysis of adhesions and not be paid for their extra work.
Yes, I've heard "just add a modifier 22 on it and provide documentation..." but seriously, has anyone ever received payment? And if so, from which insurance carriers?

 

[CodingKing]

If there is by chance a small payer that doesn't follow NCCI and you could bypass your system edits it could pay the adhesion code. As for payers allowing the mod 22, yes i have heard that are payers that will if documented well and submitted as a post payment review or appeal.

 

[cgaston]

CPT 44005 is a "separate procedure" which means it can only be billed by itself. That is why the -22 modifer with a higher charge is the only recourse we have.

We have received additional payment on services billed with -22. The most important factor is having the provider document exactly how much time was spent lysing the adhesions to prove why this was a more complex procedure. My office has a rule that LOA needs to exceed 90 minutes before we even consider applying -22. YMMV....

 

[csperoni]

We do it similarly here. If there are a couple of filmy adhesions, then I am certainly not billing -22. If there is a frozen pelvis, I will put -22 on the surgery. Be prepared to write an appeal letter. Depending on how much additional work/time is spent, I will ask for payment at somewhere around 140% of the standard fee schedule. I may not get an extra 40%, but I'll usually get something. If my doc was spending an extra 2-5 hours on the surgery, it is definitely worth my biller's time to pursue the higher payment.