October 29, 2020

Question:
While performing an enterostomy closure (44626) a tear in the small bowel was made during extensive lysis of adhesions. Can this be billed as a 44120, since it required surgical repair and couldn’t be avoided due to the severity of the lysis?

Answer:
Although the tear was from friable (fragile) tissue and the tear was not caused by a surgical accident, this repair (44120) would not be separately billing. It is still be considered an iatrogenic (inadvertent or accidental) procedure.

However, if documentation explains the increased difficulty during the procedure (including documentation of time spent in addition to the usual time for the procedure), then a modifier 22 may be indicated.

*This response is based on the best information available as of 10/29/20.