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Use of Modifier 52
My surgeon was called into a laparoscopic operation that was already underway, to perform extensive lysis of adhesions. Does he need to use a modifier 52 because the patient was already “opened”, or can we just bill for 44180 Laparoscopic lysis of adhesions?
Question:
My surgeon was called into a laparoscopic operation that was already underway, to perform extensive lysis of adhesions. Does he need to use a modifier 52 because the patient was already “opened”, or can we just bill for 44180 Laparoscopic lysis of adhesions?
Answer:
You would bill for 44180 without a modifier 52, as the surgeon performed the entirety of the procedure listed.
*This response is based on the best information available as of 08/11/22.
Separate Procedure Billing
The surgeon performed an open colectomy and found a tear in the mesentery close to the incision, 44850 Suture of mesentery is listed as a “separate procedure”, does that mean we can bill for it separately in addition to the colectomy?
Question:
The surgeon performed an open colectomy and found a tear in the mesentery close to the incision, 44850 Suture of mesentery is listed as a “separate procedure”, does that mean we can bill for it separately in addition to the colectomy?
Answer:
No, codes designated as a “separate procedure” are intended to identify procedures that are only reported if they are the only procedure performed in that anatomic area. When performed with a more comprehensive procedure in the same anatomic area, only the more comprehensive procedure is reported. In your example, only the colectomy would be reported.
*This response is based on the best information available as of 07/28/22.
Billing for Reopening of Recent Laparotomy
Our surgeon insists on billing for 49002 reopening of a recent laparotomy and a 44005 lysis of adhesions, since the case is complicated because the laparotomy was only 60 days ago. Can he bill for both in any circumstance?
Question:
Our surgeon insists on billing for 49002 reopening of a recent laparotomy and a 44005 lysis of adhesions, since the case is complicated because the laparotomy was only 60 days ago. Can he bill for both in any circumstance?
Answer:
Although this was a reopening of a recent laparotomy, lysis of adhesions was the primary procedure performed and would be the only code billable. Coding rules would follow the same guidelines for 49002 just as they do for an exploratory laparotomy 49000. When a more extensive procedure is performed, the laparotomy (in this case reopening of a laparotomy) is not separately billable. And don’t forget to add the appropriate modifier depending on the circumstance, to indicate whether the surgery was related, for example a complication, (78), an intentionally staged procedure (58) or if unrelated (79) to the original laparotomy.
*This response is based on the best information available as of 07/14/22.
2021 Evaluation and Management Codes: Is a History Required?
My coder just told me about the new guidelines for 2021 office visit codes. She said I no longer have to document a History. This doesn’t seem right to me.
Question:
My coder just told me about the new guidelines for 2021 office visit codes. She said I no longer have to document a History. This doesn’t seem right to me.
Answer:
You are wise to ask because that’s not exactly true. It is correct that the History will no longer be used to select a new patient (9920x) or established patient (9921x) visit code. However, it is expected that you will document a “medically appropriate” (per CPT™ history for each encounter.
*This response is based on the best information available as of 06/30/22.
Billing for Intestinal Tear During Enterostomy Closure
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?
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.
Billing for ICG Dye
The surgeon did a robotic/laparoscopic cholecystectomy and cholangiogram with ICG and firefly identification of biliary anatomy. He billed a 47563. Can he can bill separately for the icy green and firefly dye?
Question:
The surgeon did a robotic/laparoscopic cholecystectomy and cholangiogram with ICG and firefly identification of biliary anatomy. He billed a 47563. Can he can bill separately for the icy green and firefly dye?
Answer:
Billing for indocyanine (ICG) or Firefly TM fluorescence is bundled into 47563 laparoscopic cholecystectomy with cholangiogram and is not separately billable.
*This response is based on the best information available as of 06/02/22.