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Laparoscopic cholecystectomy w/lysis of adhesions

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bpiggott

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Iberia, MO
How would you code a Laparoscopic cholecystectomy w/intraoperative cholangiogram along with doing lysis of adhesions at the same time.

I know you would use CPT 47563 for the cholecystectomy code & the only other lysis of adhesion code I seen was the 44180 because this was done laparoscopically also. But these 2 codes are not billable together, in this case what would you charge?
 
lysis

bpiggott said:
How would you code a Laparoscopic cholecystectomy w/intraoperative cholangiogram along with doing lysis of adhesions at the same time.

I know you would use CPT 47563 for the cholecystectomy code & the only other lysis of adhesion code I seen was the 44180 because this was done laparoscopically also. But these 2 codes are not billable together, in this case what would you charge?
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Lysis of adhesions is usually not payable separately. But, if they are extensive, require a lot of extra time, a lot of extra equipment etc., then you could add the 22 modifier to show extenuating circumstances that caused more work for the surgeon. You would have to submit the report with this also. Now, having said this, it's usually not something that is paid because if it's just to remove adhesions to get to the part they want to remove, that is considered part of the procedure. I have seen very few that have required a 22.
 
This is something that recently came up in our office. I told the physician that we should code only the lap chole because that is what he went in to do. There was extensive lysis of adhesions and because that had a higher RVU they only wanted that billed. They said that became the predominant procedure. While I agreed that was the case, this confused me because my experience has been that you code for the planned procedure in this type of situation. What does everyone else think?
 
What if the surgeon repairs an umbilical hernia and then does the lap chole? Do you bill separately for the repair - I dont think I can because its an open code and I believe he is using the same incision to insert his trocar. Would a -22 be more appropriate?
 
umbilical hernia (49585) does not bundle with the lap chole (47562), therefore seperately codeable (two different areas being operated on) and no 59 would be necessary

Mary, CPC, COSC
 
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