Coding Lysis of Adhesions
Depending on the time and effort involved, lysis of adhesions might be billed separately.
CPT® includes a number of codes dedicated to lysis of adhesions (categorized by location). For example:
- Tubes and ovaries, 58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) or 58740 Lysis of adhesions (salpingolysis, ovariolysis)
- Urethral 53500 Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring)
- Intestinal adhesions 44005 Enterolysis (freeing of intestinal adhesion) (separate procedure) or 44180 Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)
If the surgeon spends significant time performing lysis of adhesions, but you cannot find a CPT® code specific to the anatomic location, you can account for the additional work by appending modifier 22.
Whether you report a separate CPT® code or add modifier 22 Increased procedural service to the primary procedure code, documentation is crucial. The surgeon must give a clear picture describing the difficulty encountered in the procedure. For example, did the adhesions distort the anatomy? Were they dense and fibrous? How much time was spent removing the adhesions before viewing the surgical field? Above all, the documentation must establish that lysis of adhesions was unusually complex and time consuming, for a given procedure.
For example, CPT Assistant (March 2003) advises:
Code 58660, Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure), can be reported in addition to the primary procedure, only if dense/extensive adhesions are encountered that require effort beyond that ordinarily provided for the laparoscopic procedure. Lysis of adhesions typically is included as part of the laparoscopic surgery performed. As code 58660 is designated as a separate procedure, modifier ‘-59,’ Distinct procedural Service, should be appended in order to indicate that code 58660 is not considered an integral component of the other procedure(s). Documentation must reflect the dense/extensive work required for the removal of lysis of adhesions.
CPT Assistant also warns, “Although this reporting reflects the intent of CPT, third-party payers may request that you report these services differently. You may wish to contact your third-party payer for specific reporting guidelines.”