General Surgery Coding Alert

Reader Questions:

Beware Adhesiolysis Bundles

Question: During a splenectomy procedure, the surgeon documents encountering dense adhesions involving the bowel and omentum, which require two hours of adhesiolysis by sharp dissection to adequately expose the spleen. Can we separately code the lysis of adhesions as 44005?

Ohio Subscriber

Answer: No, you should not report 44005 (Enterolysis (freeing of intestinal adhesion) (separate procedure)) in addition to the code for the primary procedure, 38100 (Splenectomy; total (separate procedure)).

The National Correct Coding Initiative (NCCI) edits bundle 44005 as a column 2 code with 38100 with a modifier indicator of “0,” meaning that you should not override the edit pair under any circumstances.

Do this: With documentation of the extra time and work spent on the adhesiolysis, you can bill 38100 with modifier 22 (Increased procedural services). That’s no guarantee, but it’s your best option for getting some reimbursement for the extra work.