General Surgery Coding Alert

Question: I'm having trouble getting paid for 44180 with any other procedure -- for example, with a laparoscopic appendectomy. Can I expect additional pay for this procedure, and if so, how can I bill for it?

Texas Subscriber

Answer: Performing enterolysis during a laparoscopic appendectomy (44970, Laparoscopy, surgical, appendectomy) doesn't warrant a separate 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]).

Here's why: CPT and Medicare's Correct Coding Initiative (CCI) bundle 44180 into many other procedures. That means you won't often be able to separately report the service.

Obey 'separate procedure' designation: CPT Surgery Guidelines explain that certain codes are "commonly carried out as an integral component of a total service." CPT identifies these codes with the parenthetic designation "separate procedure" in the code definition. The guidelines go on to state that you should not report the separate procedure in addition to the total procedure. You can only report a "separate procedure" code when the service is "unrelated or distinct from other procedures/services provided at that time ..."

Watch CCI: In addition to the CPT bundling issues, CCI also restricts 44180 with many codes. In fact, CCI lists 44180 as a column 2 code for 44970 with a modifier indicator of "0," meaning that you cannot override the edit pair under any circumstances.