General Surgery Coding Alert

Question: Sometimes our surgeon performs a partial colectomy, either open or laparoscopic, that entails take down of adhesions. Can we separately report the adhesions by using 44005 or 44180 to get paid for the additional work?

Arkansas Subscriber

Answer: No, you should not separately bill the take down of adhesions in addition to a code for partial colectomy.

The code for an open partial colectomy is 44140 (Colectomy, partial; with anastomosis), and for a laparoscopic procedure, the code is 44204 (Laparoscopy, surgical; colectomy, partial, with anastomosis).

You are correct that CPT^® provides the following codes for freeing intestinal adhesions:

• 44005 (Enterolysis (freeing of intestinal adhesion)) (separate procedure))
• 44180 (Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)).

But you shouldn’t report those codes in addition to the colectomy code.

Here’s why: Both 44005 and 44180 are listed as “separate procedure” codes, which means that the service described by the code is integral to any other surgery performed at the same anatomic site on the same date. In other words, 44140 and 44204 already account for routine takedown of adhesions.

Tip: The NCCI Policy Manual calls out lysis of adhesions as work that is included in all abdominal surgeries. The Policy Manual is a good reference that is the source of many of our coding rules.

Key: Don’t make the mistake of thinking that your surgeon is not getting paid for the enterolysis. Rather, realize that reimbursement for enterolysis is built into abdominal procedure pay because it occurs so often. That means your surgeon is actually getting paid for enterolysis every time he performs a colectomy, whether or not he actually has to take down adhesions.

‘Extensive’ option: If you have a rare case where your surgeon documents an extensive enterolysis that requires additional resources and time beyond the normal work involved in the procedure, you may turn to modifier 22 (Increased procedural services) to document the additional work and possible capture increased pay.