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Re: General Surgeons/Lysis of Adhesions

  1. Default Re: General Surgeons/Lysis of Adhesions
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    Recently other specialists (Gynecology, Urology, GI) have been requesting our doctors lyse the adhesions during their procedures. They often do not list our doctors as an assistant on their claims. Some are concerned that they will nick the bowel.

    They expect us to unbundle the adhesions and bill separately for them. Our doctors do not always help close when they assist the other specialists. I do not feel that it is not proper to bill a separate claim for adhesions lysed during the same Operative Session. I have considered billing for the lysis separately with a Modifier 52 and sending in correspondence, but I truly feel that we should be listed as the assistant surgeon, and maybe use a modifier 22 with the specialists code if it took an hour or more to do. I have read some comments in the past that said if the our doctor dictated a separate Operative report that they could bill separately. It still does not make it seem correct!!!

    I don't think that the patient should be billed separately for lysis and the procedure codes that the other specialist has billed. Frankly, it seems to me that the patient would suffer because the primary surgeon is not performing all of the services that are included in the CPT code that he is billing.

    Has anyone else had this problem, and how do you handle this issue.



  2. #2
    Milwaukee WI
    Default Two options

    OPTION 1: You code the lysis with a -54 modifier (I'm assuming you did no pre-operative management and won't do post-operative care either).

    OPTION 2: Modifier 62 Your surgeon is listed as a co-surgeon on the primary surgeon's op note; you list the primary surgeon as a co-surgeon on your op note. Both surgeons bill the primary surgery as - CPT xxxxx-22/62

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. Default
    Thanks for the reply! One of the problems is that the other specialists will not code as co-surgeons. They do not want to share the revenue on their procedures. Some of the codes that the other specialists bill will not even allow an assistant to bill and Modifer 52 with a letter of explanation has been consistently denied by most carrier if I try to bill the CPT for the adhesions since they are performed during the same operative session.

    I had thought about Modifer 54 on the adhesions, but I have been hesitant about doing this because I had thought that each CPT code includes the fact that you opened, closed, performed take-down of adhesions (not lengthy adhesion removal), and did what was necessary to get to the organ site where the surgery is performed. It just seemed as if the patient would be billed for two separate surgeries when only one procedure was performed. I know that you do not do the follow-up with Modifer 54, but it did not seem that they did enough work to bill a separate code. The other specialists would normally perform the takedown of adhesions with their procedures, but it seems that the have bcome hesitant to do this because they are afraid that they may nick the bowel.

    Thanks again. I would appreciate any other replies if anyone has billed and been successful under these circumstances.



  4. #4
    Columbia, MO
    I was told by a wise surgeon that in order to bill for lysis of adhesions with either a 22 or CPT code there must be documentation that supports that the adhesions were extensive and that the lysis of these adhesions had a therapeutic benefit to the patient. Otherwise to take down the adhesions is considered for the convenience of the surgeon and not separately billable. It seems as though your surgeons know this as well and are requesting other physicians to step in to do the lysis in order to clear the operative field. So I agree no matter how you slice it this is not a separately billable procedure just to do out of fear of nicking the bowel.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    I agree with the modifier 62 more appropriate medicaly,medico ethically and cost benefit ratio; and outcome point of view too.
    Adhesiolysis (when it necessitates the primary surgeon to call for another specialty surgeon) itself weighs the expected complications ,even in the hands of experienced expert surgeons.
    The question of ‘FEAR' of nipping does not arise at the first instance. It is a “LAYMAN'S TERM”.
    WE ARE DEALING WITH LIFE- Morbidity and Mortality as the PRIMARY FOCUS.
    The primary surgeon who plans the surgery, is not seeking the other surgeon for want of ‘COURAGE' to do it but it is a MUST most often in such circumstances, because the adhesiolysis is more cumbersome PROCEDURE than a clean cut picture of primary surgery/procedure.
    The complications expected, are quite reasonable and other speciality surgeon's presence/or hands on the field , is a mandatory in such cases. The primary surgeon needs the co-surgeon from other specialty or from same specialty is mandatory,(be it preoperatively planned or intraoperatively summoned for). When such complications are expected in that specific area of Surgery, for benefit of doubt or as an avoidance of complications in adhesions, is a medical necessity in that situation, irrespective of extensive adhesion or little adhesion, the presence of a Surgeon being saught itself, holds the whole responsibility being shared(however it is not a slimy adhesion as we find sometimes in Integumentary system), when it comes to internal/invasive or vital organs/nerve or vessels.
    (There are, of course, some exceptions like Intrauterine Synechae adhesiolysis, which can be carried out by a single primary surgeon with hysteroscopic procedures.
    Do the insurance companies expect those ‘expected complications' to be taken a chance in the body of the patients and then deal with those complications and pay the price, in terms of the well being of the clients, reputations, and the cost as well . “ A STITCH IN TIME SAVES NINE”.
    Modifier 54 can be considered for the Surgeon called from the same Specialty, if 62 is not appropriate.

    Thank you for your time. If this cannot be accepted , please take it as a suggestion to validate.

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