Wiki Lap. Left Oophorectomy 58661 and resection of Sigmoid protrusion.

[natashalage]

Hello. Could you please tell me if i can add 44110 to the excision of Ovary 58661 in the report below or I should just add a modifier -22? Thank you very much in advance. I am a new coder.
FINDINGS:
1. .. the uterus and cervix to be surgically absent.
2. On laparoscopy, .. to have adhesions of the sigmoid colon to the left ovary and the anterior abdominal wall. After taking down adhesions, the left ovary was still adherent to the left sidewall including the residual left round ligament. On removal of the ovary, the cyst ruptured for chocolate fluid and, after resecting the ovary, there were two areas of bowel that were stapled over an oversewn. ..The appendix was surgically absent.

PROCEDURE: Left oophorectomy 58661… for a combined abdominoperineal procedure. .. We made three laparoscopic incisions … The peritoneal cavity was insufflated with 3 liters of carbon dioxide gas …. We noted adhesions of the sigmoid colon to the anterior abdominal wall. …n the adhesions close to the bowel by sharp dissection using scissors. We dissected the mass away from the sigmoid colon. We entered the cyst for chocolate fluid and decompressed the ovary. Prior to removal, we opened up the retroperitoneum to identify the sidewall vessels as well as the ureter. We detached adhesions of the left adnexa to the right adnexa. Having taken down the various adhesions, we were able to mobilize the left adnexal mass. We ended up resecting some scar tissue that was adherent to the left round ligament and anterior abdominal wall along with the ovarian tumor. …we examined the pelvis and noted that there was a diverticulum from the sigmoid that was particularly involved with adhesions. Given the degree of adhesiolysis and despite our shar dissection, we elected to resect the small area of protrusion. .. We used an Endo GIA stapler to resect the outpouching from the sigmoid diverticulum, and this was given to Pathology. A secure staple line was noted. There was a second area on the sigmoid colon where there was some deserosalization of the bowel. …

44110-Excision of 1 or more lesions of small or large intestine not requiring anastomosis, exteriorization, or fistulization; single enterotomy

 

[csperoni]

If the bowel surgery was due to an accident or inadvertant situation by the surgeon, it is not billable. That does not seem to be the case here as indicated in "we elected to resect the small area of protrusion." There was a medical reason to perform this additional procedure.
However 44110 is not a laparoscopic code. Not my area of expertise, but I sometimes am forced to "dabble" in GI.
For laparoscopic procedures of the intestines, codes are 44180-44238. The op note excerpt does seem to fit 44111 except for laparoscopic. In the laparoscopic codes there does not seem to be a match - specifically the closest all specify anastomosis.
That leaves 3 options:
1) Billing the closest lap code with -52 for reduced. This is my least favorite of the 3 options
2) Unlisted 44238, asking to be valued as 44111. NOTE: it appears there were 2 enterotomies, not a single enterotomy under findings "two areas of bowel that were staples and oversewn".
3) Adding -22 to your existing procedure.

Any of these 3 options will require the op note and a letter supporting what you are asking for. I personally would probably go with 2 in this situation as there is a specific open code that you would match it to.

Hope that helps!

 

[natashalage]

Wow, Christine! You dissected this report So Nicely! It leaves me no question to ask. I read it twice and will read again to etch it in my brain. I have to admit this mystery looked to me very complex but with your investigational expertise you made it Fun to code. Thank you very much!