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surgery coding question

  1. #1
    Question surgery coding question
    Medical Coding Books
    I realise this might be kind of long, but any help would be appreciated. One of our general surgeon's performed:

    Laparoscopy, laparotomy, lysis of extensive adbominal adhesion more than 45 minutes, colostomy takedown with EEA, cooproctostomy, and meckel diverticulettomy.

    Op Report:

    I initially perfomred 20 to 30 minutes of general dissection to takedown adhesions: however, in the lateral aspect of the abdomen, the adhesions became dense and difficult to identifiy the bowel. I therefore converted the patient to a laparotomy midline incision. The adhesions of the small bowel were lysed preventing the internal herniation in the future and the stump was identified. The mesocolon was transected with the ligasure instrument. The proximal rectum was then transected with a contour stapler. I could not intoruce a larger sound and a 23 EEA was then utilized to perfomr a coloproctostomy. The small bowel was run and a Meckel diverticulm was identified. A meckel diverticulectomy was performed.

    These are my two codes 44800 and 44620. Does anyone agree? Also this is a medicare patient. Is there anything I can do to get reimbursed for the lysis of adhesions which is what caused the procedure to become open? According to the CCI edit I cannot code 44800 with 44005 (Open lysis of adhesion).

    Thanks for any help you might give.

  2. Default
    You can try adding modifier 22 to the codes and sending the operative report, but, only if the time spent doing the adhesiolysis is clearly documented. I would also use the 568.0 and v64.41 with your diagnosis codes. I haven't had much luck but it is worth a try.

  3. Default
    I agree with Brendal.....add 22 modifier and you can increase your fee to allow for the adhesions but make sure your surgeon dictates a very good detailed letter stating the reason for this in addition to sending the operative report. DD

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