I have a procedure where the doctor started a laparoscpic colostomy reversal, but states in the note it needed to be converted to an open laparotomy and incidental appendectomy. I know I can bill a 22 modifier with the procedure since the doctor states "after approx one hour of adhesiolysis I determined the adhesions were too adherent and too numerous to continue robitically/laparoscopically." I know I cannot bill for the appendectomy. I’m confused what to bill for lap vs open because I’m new to general surgery. I believe I read I shouldn’t bill for the lap since it wasn’t completed. What procedure can I bill for? The op report is below. Thanks!

Details of procedure: After informed consent was obtained the patient was brought to the operating room placed in supine position the operating table. The patient was orotracheally intubated by the anesthesiologist a Foley catheter was inserted. The patient was then placed in lithotomy position. The patient’s abdomen was prepped and draped in usual sterile fashion. After timeout was performed patient’s surgery and site of surgery was correctly identified. A right paramedian transverse incision was made using #11 blade scalpel dissection was carried down to the external oblique fascia using electrocautery which was incised. A 0 Vicryl stay suture in a figure-of-eight fashion was placed the rectus muscle was bluntly divided in the posterior sheath was cut using Metzenbaum scissors the abdomen was bluntly entered and a finger sweep was performed. A Hassan trocar was then inserted and the abdomen which was insufflated to 50 mils of mercury using carbon dioxide gas. There is an extensive amount of adhesions containing omentum small intestine to the anterior abdominal wall. Under direct visualization a right lower quadrant 8 mm robotic trocar left upper quadrant 8 mm robotic trocar placed using bipolar grasper and robotic scissors the adhesions were freed in the anterior abdominal wall underlying the previous midline incision as well as in the pelvis extensive amount of small bowel had adhered into the pelvis. After approximately 1 hour of adhesiolysis I determined that the adhesions were too adherent and too numerous to continue robotically/laparoscopically.
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The vertical midline incision was opened using #10 blade scalpel dissection was carried down the fascia using electrocautery the fascia was incised in the Prolene suture was removed from the midline incision. Using Metzenbaum scissors the remainder of the adhesions were taken down and the pelvis was cleared the rectal stump was identified low within the pelvis at the level of the peritoneal reflection. The colostomy was freed from surrounding intra-abdominal adhesions the external portion of the colostomy was circumferentially dissected using cut electrocautery at the skin dissection was continued on the fascia using electrocautery the fascia was circumferentially freed from the portion of colon and the colostomy was freed from its attachment through the abdominal wall. The external fascia was temporary closed using a 0 Vicryl suture in a running fashion. Next the white line of Toldt and peritoneal attachments of the descending colon were freed to allow mobilization into the pelvis. It was identified that it would easily reach with into the pelvis without tension and no portion of the mesentery was divided. An obvious pursestring stapler was used to place a pursestring around the distal portion of the colon the colostomy was then excised using heavy curved Mayo scissors. The bowel was opened and the sizers were used and a 25 EEA was determined to be the appropriate size for re-anastomosis. The anvil of a 25 EEA stapler was placed into the lumen of the colon and the pursestring suture was tied.
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Next Mr. Varney went below into the rectum and placed the sizers and dilated up to 28 on the EEA sizers. He then placed the 25 EEA stapler into the rectum and deployed the spike a spike and anvil were attached and the stapler was closed. The stapler was then fired and held for 10 seconds. Stapler was opened and easily removed from the rectum. Next a rigid proctoscope was inserted and the distal rectum and anastomosis was insufflated. There was a small leak of air noted in the right lateral portion of the staple line this was oversewn with 3-0 silk suture and again the rectum was filled with air there was no leak noted. The pelvis and abdomen were thoroughly irrigated using 2 L of normal saline with Clorpactin. The midline incision was closed using 0 looped PDS suture. The skin was closed with staples the colostomy fascia was again closed using #1 PDS. All incisions were closed with staples sterile dressings were applied the patient was awoken from anesthesia and transferred to the recovery room in stable condition.