AAPC - Back to school
Results 1 to 4 of 4

Thread: Laparotomy with massive lysis adhesions/correct small bowel volvulus

  1. #1

    Default Laparotomy with massive lysis adhesions/correct small bowel volvulus

    AAPC: Back to School

    Can someone tell me the correct way to code the following:

    The physcian converted from a lap to open laparotomy with massive lysis of adhesions and correction or repair of small bowel volvulus. Approximately 90% of the case was spent lysisng adhesions which was about 1 hour just lysing the adhesions. One adhesions has caused the bowel to twist and cause the volvulus causing an almost complete obstruction. Because of the adhesions, it was impossible for us to do this laparoscopically and we converted to open.
    An hour ws spent lysing the adhesions so we can liberate the small intestines. In the mid jejunum, we noticed a twisting of the intetines consistent with a volvulus. We lysed adhesions and were able to turn the intestines and correct the volvulus. We now continued lysing the adhesions until we came down to the area of the pelvis. A loop of terminal ileum was stuck down in the pelvis with adhesions and sharp dissection was used to liberate this part of the intestines

    He spent more than (90%,1hr) the usual time lysisng the adhesions, so I thought I could charge for that with a modifier 22 attached. Also I thought I can charge for he correction of the volvus (44050), but I am not sure which one to list as the primary procedure. there is a CCI edit that bundles 44005 into 44050. Can this be unbundled with a modifier 59? Or should I just bill the 44050 only?

    This is what I have, not sure if it is correct. Pleae let me know.

    DX's 560.9 V64.41

  2. #2
    Join Date
    Apr 2007


    Even though these services are bundled, I think you can bill both codes but this will become an appeal situation. The 44005 has more RVU's than the 44050 but I would make 44050 the primary procedure. I would use dx: 560.2 and 560.81 with the V64.41 I would not use the -59 modifier, only the -51 and -22. You will have to include the operative report and a letter of explanation as to why you are unbundling (eg. the excessive amount of time spent lysing the adhesions). If you can, inlcude the amount of time it would usually take to correct a volvulous if the adhesions were minimal. Also ask the surgeon if he performed a Ladd procedure, this would be code 44055 which would replace both of these codes. Hope this helps. Adhesions are tricky. Anyone else's input would be appreciated!

  3. #3
    Join Date
    Apr 2007
    Albany, New York


    Per the CMS NCCI edits for physicians, these two codes cannot be unbundled with a modifier.
    I would use 44050 only.
    Karen Maloney, CPC
    Data Quality Specialist

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default 44050-22

    I'd use 44050 with -22 modifier (due to extensive lysis of adhesions)

    F Tessa Bartels, CPC, CEMC

Similar Threads

  1. Exp. lap with lysis of adhesions; Small Bowel resect;Cholecystectomy
    By tldixon@mokancomm.net in forum Gastroenterology
    Replies: 0
    Last Post: 10-26-2012, 09:11 AM
  2. Replies: 1
    Last Post: 09-07-2012, 03:43 PM
  3. Replies: 0
    Last Post: 07-28-2009, 01:41 PM
  4. Lysis of adhesions and repair laceration small bowel
    By Trendale in forum General Surgery
    Replies: 1
    Last Post: 04-15-2009, 05:36 AM
  5. Exploratory Laparotomy,Lysis of Adhesions
    By Trendale in forum General Surgery
    Replies: 6
    Last Post: 04-07-2008, 02:57 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.