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Small Bowel Resection

Melissa Posted Mon 27th of January, 2020 10:34:57 AM
Hello, I need help with this operative report: The post op diagnosis is Small bowel obstruction , significant adhesive disease, left lower quadrant hernia, small bowel enterotomy, small bowel serosal tears. The procedure is described as a Diagnostic Laparoscopy converted to exploratory laparotomy, small bowel resection, primary repair of ventral hernia, repair of multiple serosal tears. thanks
SuperCoder Answered Tue 28th of January, 2020 05:07:09 AM

Hi Melissa,

 

Thank you for the Question!

 

As per the above provided limited documentation, CPT codes 44120 for small bowel resection 49561 for primary repair of ventral hernia  & 44604 for the repair of multiple serosal tears seems appropriate.

Note: AS per NCCI edit CPT Code 44604 is a column 2 code for 44120 & Code 49561 is a column 2 code for 44604. Hence, append an appropriate modifier to unbundle the edit. Kindly correlate with the detailed operative report before finalizing the codes.

 

Hope that helps!

Melissa Posted Tue 28th of January, 2020 09:27:41 AM
Thatnk you; in reviewing the detailed operative report, it says that he also performed extensive lysis of adhesions of the small bowel to ant abd wall, small bowel interloop adhesions and omental adhesions in an attempt to gain further access to the abdominal cavity; lysis of adhesions was carried out for approximately 90 minutes; the small bowel enterotomy was oversewn; several serosal tears were repaired; the majority of the small bowel that was visible was pink and healthy so we elected to repair the area of small bowel with the enterotomy; we performed a side to side functional end to end small bowel resection; the mesenteric defect was repaired; we placed an 18 French JP drain through a stab incision and did extensive investigation of the abdominal cavity; we located a left lower quadrant defect at her previous ostomy site and repaired it primarily using 0PDS suture. would those codes still stand and would this support use of a modifier 22? Thank you very much
SuperCoder Answered Wed 29th of January, 2020 02:29:50 AM

 

Thank you for the Question.
 

 

CCI edits bundles the primary procedure code (small bowel resection) with the appropriate enterolysis code (44005), we can only override the edit pair if the surgeon performs the lysis of adhesions at a different anatomic site or during a different operative session. In these cases, we can report the primary procedure code with modifier 22  "when the adhesions represent a significant amount of work, not when the lysis is done simply to access the surgical site.
      As per the above-provided documentation, it would be appropriate to add modifier 22 with primary procedure code to get the reimbursement for additional work performed along with small bowel resection.
 
Hope that Helps!
Melissa Posted Wed 29th of January, 2020 09:18:23 AM
So based on the above documentation, the correct coding would be 44120-22, 44604-59-51, 49561-59-51. Is that accurate? Thank you
SuperCoder Answered Thu 30th of January, 2020 02:05:31 AM

Hi,

 

Yes, the suggested code(s); 44120-22, 44604-59-51, 49561-59-51 are most relevant to the above limited provided documentation. We suggested code 44604 for serosal tear; but, as per CCI edit, CPT code 44604 is showing the bundling conflict between code 44120. So, it is advised to go through your detailed operative note to rule out the bundling for code 44604.

Generally the serosal tears are caused during the same operative session or when carried out with lysis of adhesions. Sometimes, payer guidelines restrict the billing of serosal repair along with other major procedure(s). Kindly check with your respective for any reimbursement guidelines around the same.

 

Also note, if the serosal tear was repaired in the small intestine, the appropriate code will be 44602: Suture of small intestine (enterorrhaphy) for a perforated ulcer, diverticulum, wound, injury or rupture; single perforation, instead of 44604.

 

Hope that Helps!

Melissa Posted Thu 30th of January, 2020 08:16:46 AM
Thank you very much!
SuperCoder Answered Thu 30th of January, 2020 23:22:37 PM

Thank you, happy to help.

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