Resolved Coding Help

[LoganR_46098]

One of my colleagues had coded the following and our auditing team said it should be coded differently. We are posting here to get some more opinions. We coded 44180 and the auditing team said it should be 49320, below is the scrubbed OP note:

"We placed an Optiview 5 mm laparoscopic port immediately above the umbilicus by making a 5 mm incision and with direct visualization with a camera, I entered into the abdominal cavity, insufflated pneumoperitoneum to 10 mmHg. Subsequently, we inserted 8 mm AirSeal solution port in the right lower quadrant and secured and initiated the AirSeal insufflation to 12 mmHg.

We used a laparoscopic grasper and identified minor adhesions of the sigmoid colon to the left fallopian tube and the left ovary and we performed adhesiolysis in a blunt fashion and freed up completely the left side of the sigmoid colon off the left fallopian tube and ovary. It appears that there was a 7 x 8 am cyst with serous fluid in the left ovary, which appeared to be intact at this time. There was no evidence of malignant transformation on direct inspection. The cyst was left in place.

We clearly identified the uterus and the cervix and appeared to be completely free and not adherent at all to the upper portion of the rectum or colon, so therefore there was no rectovaginal or colovaginal fistula and there was no connection to the bladder or to the uterus. Therefore, the presence of a colovesical or colovaginal or colouterine fistula or any fistula in the rectum was completely ruled out in this procedure.

The procedure was completed. We evacuated pneumoperitoneum. We removed the laparoscopic ports and subsequently we approximated the skin edges with a 4-0 Monocryl in subcuticular running fashion and injected local anesthesia, a total of 30 mL 0.25% Marcaine with epinephrine and the Dermabond was applied and the procedure was completed."

 

[Alicia]

Remember laparoscopic surgical codes have a 90-day global for both Medicare and commercial insurance carriers. Bundled services, for which one should not separately charge when billing primary laparoscopic/robotic procedures, include CPT code 49320, diagnostic laparoscopy, and 44180 laparoscopic lysis of adhesions. When adhesions are extensive, and their treatment prolongs the primary operative procedure, add modifier 22 to the operative CPT code to indicate the increased operative time required to complete the primary procedure. With laparoscopic procedures one may also use the following modifiers including modifier -50 for bilateral procedures, modifiers -80 and -82 for surgical assistants, and modifier -62 for cosurgeons.

Coding Corner By: Michael Ferragamo, MD, FACS Coding of Laparoscopic and Robotics Procedures

Per CMS:
9. Open enterolysis (CPT code 44005) and laparoscopic enterolysis (CPT code 44180) are defined by the “CPT Manual” as “separate procedures.” They are not separately reportable with other intra-abdominal or pelvic procedures. However, if a provider performs an extensive and time-consuming enterolysis in conjunction with another intra-abdominal or pelvic procedure, the provider/supplier may append modifier 22 to the CPT code describing the latter procedure. The local MAC will determine whether additional payment is appropriate.
5. Laparoscopic lysis of adhesions (CPT codes 44180 or 58660) is not separately reportable with other surgical laparoscopic procedures.

 

[LoganR_46098]

Thank you for quick reply. I guess what we are trying to determine is if the op note supports coding the lysis of adhesions over coding CPT 49320.

 

[Darcy]

In my humble opinion, yes 44180 is coded only since diagnostic scopes are bundled into a surgical scope procedure.

 

[LoganR_46098]

In my humble opinion, yes 44180 is coded only since diagnostic scopes are bundled into a surgical scope procedure.

Thank you very much!