Bianca Posted Mon 15th of August, 2016 19:24:01 PM
Our doctors spent about 20 minutes removing adhesions so the port for the laparoscopic prostatectomy could be placed. Can we bill anything for this? The dictation reads:
"The procedure was begun by anchoring a foley catheter in the bladder. A Veress needle was inserted beneath the left costal margin
into the peritoneal cavity, and CO2 insufflation was begun after a negative aspiration and saline drop test. Once adequate
pnemoperitoneum was achieved, a 12 mm camera port was placed lateral to the umbilicus (assistant port) on the left due to the patient
having a previous primary umbilical hernia repair and concern for adhesions. The abdominal cavity was inspected with the camera,
and indeed there were adhesions at the umbilcus were the camara port needed to be placed. These appeared only to be omentum
without any small or large bowel involved. The left lateral robotic port was placed and a 8 mm scope was placed through this port. Hot
sissors were then used to take downt he adhesions systematically for 15-20 minutes until all the omental attachments were down and
the working area was free of any interference with large working areal. There were no injuries noted from the Veress needle, and the
remainder of the abdomen was otherwise normal. Under direct vision, 2 robotic trocars were placed. Two of the trocars were placed
to the right of the midline. All trocars were appropriately spaced. A 12 mm camara port was placed in the midline. The patient was
placed in steep trendelenburg position and the robot was docked."
SuperCoder Answered Tue 16th of August, 2016 00:50:10 AM
Greetings from SuperCoder!
Please note that everyone has adhesions and there is an expectation that the surgeons will lyse them when encounter during surgery. But when the adhesions are dense due to previous surgeries or chronic disease, then you should look for modifier 22. CPT® does not provide specific direction as to the specific amount of time and/or percentage increase of time or work required to compliantly report modifier 22. But the general rule of thumb is that the surgeon must spend at least 50 percent more time and/or put in at least 50 percent more effort than normal for you to append modifier 22. There should be documentation of at least a 50 percent increase in work and/or time to justify use of modifier 22. Additional circumstances that could merit using modifier 22 include removal of significant scarring or adhesions.
Please feel free to write to us if you have any concern or query.