Question about 44005

akmorgan

Networker
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58
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I have a question about billing 44005 with other procedures and will appreciate any help on this....
My physicians feel that when they do lysis of adhesions with other procedures that even though it is a bundled code, it should still be billed when it is extensive and requires extra time. I have been told to try to bill it with a -22 modifier to show the additional work and to make sure that the physician has documentation in their op note as to why it was extensive and the amount of time it added to the procedure. I have billed this way to several different payers, had to do appeals and still not successfull with getting the payment. Can anyone provide information about this or tell me where I may could find additional information about billing lysis of adhesions with other procedures.
Thank you in advance for the information.
 
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Nashville
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I believe if you look in your CCI edits 44005 has a 0 next to it indicating that it can't be billed with other procedures. Your only other option the way I understand it is to add a 22 modifier. As you stated, the physician should indicate in the op note how much extra time was required and why it was difficult.
 

mitchellde

True Blue
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Columbia, MO
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The 22 modifier must be appended to the other procedure performed.
Lysis of adhesions is routinely not considered medically necessary when performed with another procedure because adhesions are common and the physician does the lysis to make the procedure easier for him to perform, the note must show that the adhesions were extensive and the lysis of the adhesions had a therapeutic value for the patient. Then the 22 modifier can be appended, a copy of the operative is required when the 22 modifier is used.
 
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