Camille Posted Mon 09th of September, 2019 21:40:00 PM
Performed: 44970, Lap Appendectomy and 44180, Lap LOA. There is a mutually exclusive edit. 44180 is a column 2 code to 44970. Is it inappropriate to bill the column II code (44180) by itself-due to it having the highest RVU? Or must one bill the column 1 code as 44180 is considered an integral part of 44970? Thank you.
SuperCoder Answered Tue 10th of September, 2019 03:27:18 AM
As per the NCCI Manual 2019, (CHAPTER 6, Page no. 10)
“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 may append modifier 22 to the CPT code describing the latter procedure. The local carrier (A/B MAC processing practitioner service claims) will determine whether additional payment is appropriate.”
On the basis of NCCI, the best code for the procedure will be 44970 (Laparoscopy, surgical, appendectomy) with modifier 22 (Increased procedural services) to account for the extra effort the surgeon documented for lysis of extensive adhesions.
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