Camille Posted Sat 12th of October, 2019 18:55:18 PM
A lap Sigmoidectomy and Splenic Mobilization procedure is started. A laparoscopic splenic take-down was performed and then surgeon encounters colon cancer invading into the left abdominal side wall. At this point, the surgery was converted to an open procedure and the Sigmoidectomy was completed. The op note describes “the abdominal side wall was resected en bloc with the cancer.” And “I used a Bovie to resect abdominal wall that was adhered to the sigmoid colon.” I am coding the Sigmoidectomy and the Splenic Mobilization 44145, +44139 C18.7, Z53.31. May I also code for the Abdominal Wall Resection? If not, would a modifier -22 be justified? Thank you very much!
SuperCoder Answered Mon 14th of October, 2019 06:02:29 AM
In CPT code 44145, partial colectomy is the removal of a part of the colon that has been affected by the disease. In extreme conditions, the physician may decide to remove the complete colon. Once the colon or a part of it is removed, the remaining ends of the gastrointestinal canal are stretched and connected together. In some cases, when the remaining ends cannot be connected, the physician makes an anastomosis (artificial passage) by connecting the remaining part of the colon to a surgical opening in the abdomen. This opening passes the waste product out of the body into a bag attached to the patient's body. On that basis, your code selection is correct for colectomy and CPT 44139 is also correct for splenic flexure mobilization. Since, surgeon found the adhered wall to the colon, then is appropriate to append modifier 22 with it.
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
An unusual procedure is not when the physician took only a few extra minutes on the patient’s case or when the physician documents that the procedure was only slightly more difficult. There is an average range of difficulty for every procedure. A procedure could be slightly more difficult and still meet the definition of the procedure and not warrant appending modifier 22.
Hope this helps!