Billing for Intestinal Tear During Enterostomy Closure

Question:

While performing a cholecystectomy a tear in the small bowel was made during extensive lysis of adhesions. Can repair of this injury be billed in addition to the cholecystectomy? It was unavoidable since it was the consequence of the extensive lysis required?

Answer:

Although the tear was unavoidable, the repair would not be separately billing. It is still be considered an iatrogenic (inadvertent or accidental) procedure.

However, if documentation supports the increased difficulty during the procedure (including documentation of time spent in addition to the usual time for the procedure), then a modifier 22 may be indicated.

*This response is based on the best information available as of 06/16/22.