Lysis of adhesions

I have a provider that did extensive lysis of adhesions (adhesions due to 2 previous laparotomy incisions) with placement of a laparoscopic jejunostomy tube. Would it be appropriate to bill the jejunostomy (44186) with modifier 22? Or can you bill the jejunostomy (44186) and the lysis of adhesions (44180) separate??

re: Lysis of adhesions

When using modifier -22, the surgeon should DOCUMENT the TIME it usually takes to do the procedure and the TIME for the current procedure (ex, normally takes 45 minutes but due to__________ the procedure lasted 120 minutes.).

Do not code 44180

re: Lysis of adhesions

It's not only about time. Per AMA Guidelines:

"This modifier should be used only when additional work factors requiring the physician's technical skill involve significantly increased phyisicain work, time, and complexity of than when the procedure is normally performed. The procedure and/or service may be surgical or nonsurgical. The reimbursement for a procedure already takes into account that sometimes the procedure will be simpler and other times more difficult than normal. However, there are times when a procedure will be significantly more difficult.
In some circumstances, surgeons perform services or procedures that entail increased physician work than that described by the CPT® code descriptor. In many cases, there are not additional or add-on codes to describe the increased complexity of the service. In these cases, modifier 22 should be appended to the CPT® code(s). Documentation must support the substantial additional work, and the reason for the additional work such as time, increased intensity or technical difficulty of the procedure performed by the practitioner.
Modifier 22 is appropriate in reporting unusual operative cases, such as the following:
* Trauma extensive enough to complicate the particular procedure and that cannot be billed with additional procedures
* Significant scarring requiring extra time and work
* Extra work resulting from morbid obesity
* Increased time resulting from extra work by the physician"