General Surgery Coding Alert

Question: How would I code an exploratory laparotomy with division of adhesive band and lysis of adhesions? The diagnosis was 560.81 (intestinal or peritoneal adhesions with obstruction [postoperative] [postinfection]).

Illinois Subscriber

Answer: Division of the adhesive band typically refers to cutting of a specific adhesion (or adhesive band) causing the obstruction. No code describes such a division. Rather, this procedure is considered a part of lysis of adhesions. When a surgeon goes in to repair an obstruction and lyses adhesions, eventually he or she will find the adhesive band actually causing the obstruction and then cut it, says M. Trayser Dunaway, MD, a general surgeon in Camden, S.C.

When open lysis of adhesions is performed, the proper code is 44005 (enterolysis [freeing of intestinal adhesion] [separate procedure]). The exploratory laparotomy is bundled with 44005 and should not be billed separately. Had another procedure been performed during the same operative session (for example, an appendectomy), 44005 also a separate procedure would likely be bundled with the primary service.