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Wiki Accidental puncture during procedure

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Thouvenel

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I'm wondering if anyone has any documented information on accidental puncture repairs while another procedure is being performed. The scenario is my surgeon was performing laparoscopic hernia repair and when putting the trocar in pierced the bowel. He wants to bill for an enterotomy since he had to convert to open procedure, perform significant lysis of adhesions, perform the enterotomy and repair the hernia. I'm at a loss as to if we can actually bill that enterotomy????
 
If your doctor did the puncture he cannot code the enterotomy. It is sort of like if you break it, you bought it!! If he has documented the lysis well and shows how much more time and effort it took to do, then you could bill with a -22 modifier and also he needs to use the ICD-9 code for lap procedure converted to open. Otherwise, everything would be included in the code for the hernia repair.

Hope that helps!
 
we had this happen occasionally during cardiothoracic surgery and we told the surgeons flat out that it would be irresponsible and immoral to code for repair of any accidental lacerations that they caused. I wouldn't even consider a modifier 22, if they don't want to spend extra time on the patient then don't puncture anything and stick to your original plan of the lap approach.
 
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