Coding Guidance-When to report laparoscopic lysis of adhesions separately....?

 Lysis of Adhesions

 

Coding Clinic for HCPCS Third Quarter 2010 Page: 5

Coding advice contained in this issue is effective with procedures/services provided after October 15, 2010 unless otherwise noted.

 

QUESTION #14

 

A patient with chronic pelvic pain and severe dyspareunia presents for laparoscopy. The patient was brought to the operating room and given general anesthesia. The laparoscopy was started and numerous adhesions were found between the omentum and uterus, as well as the omentum and anterior abdominal wall. These extensive adhesions were taken down with sharp and blunt dissection and a Ligasure device was also utilized to remove these adhesions. This portion of the procedure required significant operating time before the remainder of the operation was completed, which included right salpingo-oophorectomy, fulguration of pelvic endometriosis, and chromopertubation. Would it be appropriate in this scenario to separately report the lysis of adhesions?

 

ANSWER

 

Lysis of adhesions are typically included as part of the laparoscopic procedure. However, if dense and/or extensive adhesions are found that require effort beyond that require additional work outside of the procedure being performed, it would be appropriate to separately report the lysis of adhesions. Therefore, based on the operative report submitted, it would be appropriate to report CPT code 58660, Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure), in addition to CPT codes 58661, Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy), and 58662, Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method, for the procedures performed. Modifier 59, Distinct Procedural Service, should be appended to CPT code 58660 to indicate that the procedure reported is separate and distinct from the main procedure being performed. Please note, however, to separately report lysis of adhesions documentation must support that dense and/or extensive adhesions were encountered and that they required a significant amount of additional work to remove the adhesions.