ICD-10-CM Documentation 2021 (Essential Chartin Guidance to Support Medical Necessity) 1st Edition Set)

Lysis of adhesions are mostly included in the laparoscopic procedure. The adhesion sometimes increases the physician work. Yes, in most of the cases there is a lot of dense and extensive adhesions which required lot of effort beyond the normal work other than the procedure performed. In short, these extensive adhesions increase the job of the physician or surgeons which needs to paid separately. So, we have to append modifiers as well to the procedure code for proper reimbursement. Hence, coding cpt code for lysis adhesions becomes very important in such scenarios. We have CPT code 58660, 58740 and 53500 coding of lysis of adhesions with different techniques in medical coding; we will check them one by one.

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Use of CPT code 58660, 58740 and 53500

Laparoscopy procedures are used for lysis of adhesion. In Laparoscopic procedure, scope is inserted into the abdomen through small incisions into your body to study the diagnosed area. First trocar ports are introduced, these ports are sharp-ended hollow tube which is inserted into the abdomen, and serves as an entry point for the scope. Additional ports are used to have a proper view of the internal structures of the abdomen. The use of number of ports does not have any effect on the CPT code. Once all the trocar are inserted, the doctor performs the actual surgery or procedure.CPT code 58660 is a separate procedure. It is used to report procedure which is done laproscopically and separately, distinct from the main procedure which is being performed. But, to report CPT code 58660, it is necessary the report should clearly document the dense or extensive adhesions which required significant amount of additional work. This extra work done to remove these adhesions needs to get paid and hence CPT code 58660 should be reported separately along with main procedure code.

58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) Also, we have to report procedure code 58740 for coding removal of adhesion adhering to the ovaries or the fallopian tubes. To report this procedure CPT code 58740 should be used.

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58740 Lysis of adhesions (salpingolysis, ovariolysis)

Urethrolysis as the name indicates the lysis or cutting of obstructive adhesions that have grown to fix the urethra to the pubic bone. This procedure is used to treat the obstructive voiding symptoms. It is a distinct operative procedure only for women who have earlier undergone uretheral suspension procedure and then subsequently developed excessive periuretheral scarring. CPT Code 53500 should be used to report the urethrolysis through tranvaginal approach.

53500 Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring)

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Use of CPT code 44005 and 44180 for Lysis of Adhesions

For coding laparoscopic enterolysis, we have separate CPT code 44180 for removal of adhesion. This procedure helps in removal of intestinal adhesions. Also, we have separate code for an open procedure without laparoscope, in which the physician directly enters the abdomen through the midline abdomen incision and removes all the intestinal adhesions. CPT code 44005 is used to report these procedures.

44005 – Enterolysis (freeing of intestinal adhesion) (separate procedure)

44180– Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)

Suppose, a surgeon perform an open abdominal procedure on a patient with extensive adhesions from previous surgeries. It takes you 60 minutes to lyse these adhesions before the surgery can be accomplished. So, should it be appropriate to report 44005, enterolysis (freeing of adhesion) along with the code for the primary surgery?

No, we should not report CPT code 44005 in such cases. CPT code 44005 and 44180 are designated as “separate procedures”. They are considered integral to the primary procedure at the same anatomic site. These procedure codes should not be coded in addition to the primary abdominal procedure, instead a 22 modifier should be reported for increased procedure service, additional payment for the extra work.