tci General Surgery Coding Alert - 2002 Issue 11

READER QUESTION: Laparoscopic Fundoplications

Question: I recently encountered two different situations with laparoscopic fundoplications: In the first case, the physician used mesh reinforcement with the fundoplication. The second was an esophagogastric myotomy with anterior fundoplication. The physician mentions, "Myotomy estimated about 5 cm long standing just above level of hiatus." How should I report these? General Surgery Discussion Group ParticipantAnswer: In each case, modifier -22 (Unusual procedural services) provides the best solution for billing the "additional" procedure if documentation can prove that significant additional time or work were required to complete the surgery. CPT does not contain a code to describe separate...

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