General Surgery Coding Alert

Question: While removing an adnexal mass, we encountered extensive adhesions from the patient's bowel wall to the abdominal wall. A general surgeon was called in to lyse the adhesions, which took three hours. The patient was already open, and the surgeon did not participate in the rest of the surgery. Which modifier should we use? California Subscriber Answer: Lysis of adhesions (44005, Enterolysis [freeing of intestinal adhesion] [separate procedure]) normally carries 25.02 relative value units (RVUs). The situation described is unusual. Additional payment may be warranted due to the additional time spent and work performed by the surgeon, but the value of 44005 includes the opening and closing of the patient, which the surgeon did not do in this case. This makes the procedure a reduced service.

If possible, the surgeon should call his or her office before performing the service so billing staff can obtain preauthorization for the lysis of adhesions to ensure that 44005 is billed successfully. Otherwise, this claim would likely not be paid on first submission (unless the other surgeon's claim arrives after the general surgeon's 44005 claim). You should also include a cover letter explaining the unusual circumstances with the claim. Otherwise, the general surgeon may be able to bill only for an assist during the primary procedure (appending the appropriate procedure code with modifier -80 [Assistant surgeon]). If co-surgery is permitted on the procedure, you may be able to bill using modifier -62 (Two surgeons). Note: If modifier -62 is appended, the surgeon must dictate a separate operative report. But no report is required if modifier -80 is attached. You Be the Coder and Reader Questions were answered by Marcella Bucknam, CPC, billing and compliance coordinator at the University of Nebraska Medical Center's department of surgery in Omaha; Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist in North Augusta, S.C.; M. Trayser Dunaway, MD, FACS, a general surgeon in private practice in Camden, S.C.; Elaine Elliott, CPC, a general surgery coding and reimbursement specialist in Jensen Beach, Fla.; Arlene Morrow, CPC, a coding and compliance specialist in Tampa, Fla.; and Kathleen Mueller, RN, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill.