There is no way to ethically capture pay for the extra work when your surgeon cuts through adhesions during abdominal surgery. Right?
Wrong! Our experts say you can. Read on to learn the circumstances that warrant additional billing, and the coding methods to capture adhesiolysis pay.
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Identify Conditions for Separate Enterolysis
Although CPT® provides the following two codes for adhesiolysis, “separate procedure” rules and Correct Coding Initiative (CCI) edits bundle the service with most abdominal surgeries:
- 44005 — Enterolysis (freeing of intestinal adhesion) (separate procedure)
- 44180 — Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure).
Those restrictions mean that you should separately report freeing of intestinal adhesions only under these three circumstances:
- Enterolysis is the only procedure your surgeon performs during the operative session
- The adhesions are in a different anatomic site or surgical session from the primary procedure
- The lysis is extensive and requires much more time and effort than is typical for the primary procedure.
Caution: Although CPT® identifies number 3 (above) as an appropriate condition for reporting a separate adhesiolysis code, Medicare and most other payers won’t allow you to bill separately when the surgeon performs enterolysis in the same area as the primary procedure. Read on to see how a modifier can help when adhesiolysis requires extensive additional work.
Learn the Methods to Capture Enterolysis Pay
If CCI edits bundle the primary procedure with the appropriate enterolysis code 44005 or 44180, you can only override the edit pair if the surgeon performs the lysis of adhesions at a...
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