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Coding help for adhesions and dissection of ureters

Georgia Posted Wed 15th of May, 2019 15:00:38 PM
Our doctor was called to assist in hysterectomy for patient with very large uterus. Report says incision was already opened, so he just enlarged incision,taking back adhesions from back of bladder to anterior wall of uterus and clearing the cervix, then starting taking the uterine pedicure both on right then left and freed the uterus away from bladder and ureter, then primary MD finished. Would I use 50715? Thanks for your help
SuperCoder Answered Thu 16th of May, 2019 07:33:58 AM

In CPT 50715 (Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis), the provider makes an incision in the skin of the abdomen over the location of the ureter. He then dissects down through subcutaneous tissue, or just under the skin and the muscles to expose the ureter. The provider then identifies the retroperitoneal fibrous tissues surrounding or adhering to the ureters. The provider dissects all the fibrotic tissues to free the ureter. The provider then reshapes the ureter with the help of sutures, positioning the ureters if possible away from the fibrotic tissue. Otherwise, he divides the ureters and repositions or reattaches the ureters to the kidney. The physician may insert a small catheter in the ureter for healing and to reduce the leakage of urine. The provider may place a drain tube into the abdomen through a separate pierce incision in the abdomen, and he inserts a bladder catheter to precisely monitor the urine output from the kidneys. Finally, he stops all bleeding and closes the abdominal wound by suturing the layers of tissue together.

However, in the provided report, the work has been performed on the uterus, but not on the ureters. Since, both are the different procedures on different structures, then CPT 50715 ((Ureterolysis) would not be appropriate to use.

For abdominal hysterectomy procedure, you can use the code from CPT code range 58150-58240 and for vaginal hysterectomy CPT code range 58260-58294 can be used. Check your documentation and select the code accordingly.

On the other hand, adhesion-lysis and clearing the surrounding parts will not be paid separately. Although, if you feel that extra work has been performed during the procedure, then modifier 22 (Increased Procedural Service) can be append with the procedure code.

In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:

  • Increased intensity
  • Additional time
  • Technical difficulty
  • Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician

Also, append modifier 80 with the procedure for the assistance surgeon.

Hope this helps!

Georgia Posted Tue 21st of May, 2019 19:24:29 PM
I don’t think I made myself clear. There was one doctor performing hysterectomy, another assisting, and my doctor was then called in as 3rd to help,whose role was to take down adhesions between large uterus and bladder and to dissect both ureters away from the uterus. Can I bill 40005 with modifier 62? If so, what if primary doc doesn’t use -62? also, can I bill for dissection of ureters? I am at a loss. Thanks for any suggestions
SuperCoder Answered Wed 22nd of May, 2019 06:18:44 AM

During the major procedure like hysterectomy, adhesion-lysis and clearing the surrounding parts will not be paid separately. As suggested, for the extra work append modifier 22 (Increased Procedural Service) with the procedure code. However, 40005 is invalid code.

Since your doctor is 3rd help, so check that 2nd Doctor was assistant or co-surgeon, if assistant then append modifier 80 with hysterectomy procedure for second doctor, and for 1st and 3rd (your doctor) as per guidelines, it has to be appended modifier with 62 (Two Surgeon) with the procedure. On the other case, if all the 3 doctors are co-surgeons, then append modifier 66 (Surgical Team).

Ap per your scenario, a surgical team is typically three or more providers of different specialties and other highly skilled clinicians performing work on the same procedure, often using complex surgical equipment. Each provider on the team should document the procedure in the patient’s record. Each provider reports the same procedure code to the payer, appending modifier 66 to the code.

Modifier 66 tells the payer that the provider was part of a surgical team, and the insurance pays each surgical team provider a specific amount instead of paying one provider the full amount for the procedure.

Hope this helps!

Wish for best reimbursement.

Georgia Posted Wed 22nd of May, 2019 09:58:51 AM
Thank You. Yes this helps
SuperCoder Answered Thu 23rd of May, 2019 01:36:38 AM

Thank you, happy to help.

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