General Surgery Coding Alert

Question: The surgical note states that during a laparoscopic procedure, the surgeon encountered omental adhesions that made visualization difficult and required extensive lysing to free a section colon to access an area of abscess. The surgeon states, “I lysed loops of bowel, and I removed the appendix. I exposed additional adhesions of the sigmoid bowel to the right cul-de-sac and lower pelvis as well as a large abscess, right of the sigmoid bowel. I placed a Jackson-Pratt drain to drain the pelvis.” How should we code the procedure?

Texas Subscriber

Answer: The best code for the procedure may be 44970 (Laparoscopy, surgical, appendectomy) with modifier 22 (Increased procedural services) to account for the extra effort the surgeon documented for lysis of extensive adhesions.

You cannot separately report 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]) in addition to the appendectomy code. Code 44180 is a “separate procedure” code, which means that the work is bundled into the code for the more extensive procedure, if there is one.

Finally, you should normally consider placement of drains and catheters as an integral part of a procedure. In this case, you won’t separately code for the Jackson-Pratt drain.