Follow these 4 tips, and your claim will pass with flying colors
Do you often include lysis of adhesions in the primary surgery? Truth: You can get paid separately for the lysis if the adhesions are extensive.
What they are: Pelvic adhesions are bands of fibrous scar tissue that can form in the abdomen and pelvis after surgery or due to infection. Because adhesions connect organs and tissue that are normally separated, they can lead to a variety of complications, including pelvic pain, infertility and bowel obstruction. Adhesions commonly form on the ovaries, pelvic sidewalls and fallopian tubes.
Capture Adhesiolysis With These CPT Codes
Although ob-gyns generally deal with lysis of adhesions in only four sites, CPT provides six codes for the associated procedures:
Important: Generally, you won't use these codes if the ob-gyn does anything else, says Rachel Hollis, CPC, billing manager for Galisteo OB GYN Associates in Sante Fe, N.M. Rationale: -They are included in the primary procedure,- she says.
You should separately report adhesiolysis when performed with another procedure(s) only when:
1. lysis of adhesions is extensive
2. the adhesions are in a different anatomic site from the main procedure(s).
Consider Mod 22 for Extensive, Nonincluded Lysis
If the lysis of adhesions is extensive and the Correct Coding Initiative (CCI) or other bundling software includes this extensive service in the primary procedure, you should add modifier 22 (Unusual procedural services) to the primary procedure code. Otherwise, you should report extensive adhesiolysis separately.
You should use modifier 22 only rarely, Hollis says. Caution: Every surgeon has cases that are harder than average and ones that are easier, and just because a case is more extensive or time-consuming than another is not sufficient reason to use modifier 22.
To report modifier 22, you should have supporting documentation that details the physician's extensive time and work effort, Hollis says. Modifier 22 will most certainly initiate a request for information from your carriers, so make sure the operative report substantiates the claim.
The following tips will help you pin down when you should report lysis of adhesions separately.
Tip 1: Separate Codable From Noncodable
When determining whether you should code adhesiolysis in addition to the primary procedure, you first have to examine the ob-gyn's documentation. Carriers usually don't reimburse separately for removing soft, filmy adhesions by blunt dissection when the [...]