I am in a bit of a quandary. My surgeon performed a total proctectomy abdominoperineal approach on a patient with a new diagnosis of primary rectal CA. There was extensive adhesiolysis required to support the use of modifier -22.

Two years ago, this patient had a primary sigmoid CA removed by sigmoid colectomy with a permanent colostomy.

The correct CPT code for this, as documented, would be 45110 with -52 since the colostomy was not performed.

So, my quandary is – is it appropriate to use both modifier -52 and -22 on one line item? They effectively cancel each other out – for payment purposes.

TYIA,
Karen