Ob-Gyn Coding Alert

Question: The ob-gyn performed a laser laparoscopy with lysis of bowel sidewall adhesions. He also did lysis of cul de sac scarring and endometriosis. Is there more than one billable code for these procedures?

New York Subscriber

Answer: You would report a lysis of bowel adhesions with 44200 (Laparoscopy, surgical; enterolysis [freeing of intestinal adhesion] [separate procedure]). For the surgeon's removal of the endometrial implants, you would use 58662 (Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method). And bill the lysis of any other type of adhesions via the laparoscope with 58660 (... with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]).
 
Unfortunately, you can't report all these codes together. Most payers, including Medicare, bundle adhesiolysis with any other procedure your ob-gyn performs. Consequently, you should report these procedures as 58662-22 (Unusual procedural services). Using the modifier assumes, of course, that the surgeon's documentation supports significant work in performing the lysis.