Lap lysis of adhesions, Lap Cholecystectomy


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Busy morning! Hope someone is able to help.

1. Laparoscopic lysis of adhesions
2. Laparoscopic cholecystectomy w/ intraoperative cholangiogram

adhesions in the right upper quadrant. port placed under direct vision. adhesions were lysis using electrocautery and sharp dissection. Approx 15 min of operative time.

peritoneum overlying the gallbladder was incised. Neck of gallbladder circumferentially dissected. cystic artery dissected due to it's anterior position and obstruction of view to cycstic duct. artery divided and clipped. gallbladder was extended and neck was circumferentially dissected.

cholangiogram catheter advanced throught gallbladder neck into cystic duct. gallbladder neck clipped and catheter noted to have good flow into duct. cholangiogram was taken and reviewed noted to have good visual of bilateral hepatic ducts, common duct, cystic duct, and good drainage into duodenum. no evidence of stones or obstructions.

duct circumferentially dissected, duct then divided. Gallbladder dissected from liver bed. abdom irrigated.....
Sorry to be the bearer of bad news but the two codes-47563 (lap chole w/cholang) and 44180 (lap lysis of adhesions) bundle out and no modifier is allowed which means you cannot bill the two of them together. Now you can bill out the lap chole/cholangiogram with a mod 22 but you probably wont be successful as the surgeon indicates (from what I can see of the available op note) that only an additional 15 minutes was needed which probably will get you no sympathy unless it takes about an extra hour or more above and beyond what would have been needed to complete the procedure. Keep in mind that CCI edits only apply to CMS claims, not to private carriers . However, that being said more private carriers than not also apply the CCI edits to their payment decisions. But you can try. The next thing to consider is that the RVU for the lysis of adhesions is higher than the lap chole. I myself would not be comfortable charging for the lysis of adhesions only if the reason for the surgery was to peroform a cholecystectomy, but that would probably be a decision for the provider to make. It stinks, but there it is. The harder you work, the less you get paid. :(