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!
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