Adhesiolysis beyond the usual access work

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Medicare outpatient digestive professional service

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Planned service

Fictional adult with a history of abdominal surgery undergoes an open small-bowel resection for a documented benign stricture. This exercise addresses the professional procedural work. The diagnosis is supplied by the clinician; the learner is not asked to infer the cause of adhesions.

Operative difficulty

The report documents dense adhesions attaching several small-bowel loops to the abdominal wall and one another. The surgeon describes careful dissection needed to expose the planned resection segment safely. There is no separate independent enterolysis operation after the resection encounter ends.

Work documentation

The surgeon records 80 additional minutes devoted to this dissection beyond the usual exposure, explains the affected anatomy and why the work was substantially greater than typical, then completes the bowel resection with anastomosis. No iatrogenic injury is reported in this fictional case.

Review request

The preliminary worksheet adds enterolysis as a separate procedure. Review NCCI’s intra-abdominal relationship and the increased-work pathway. The documented extra effort can support consideration, but the exercise does not guarantee a payer’s payment decision or replace its submission requirements.

Your coding worksheet

Separate the principal operation from work needed for access.
Identify the evidence of unusual additional effort.
Evaluate a separate enterolysis line.
Explain the purpose and limits of modifier 22 review.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

The principal service is the completed bowel resection, with adhesiolysis needed for the operative work.
The record supplies additional time, anatomy and explanation rather than merely naming dense adhesions.
NCCI E.9 does not independently add enterolysis to the other intra-abdominal procedure.
The documented unusually extensive work supports investigating modifier 22 on the primary operation, subject to complete reporting and payer review; it does not guarantee extra payment.

Reference sections: E.9

Practice the linked chart questions