So the question at the top was written back in 2015 and answered then. Is your add-on question referring to this particular surgery or a different surgery. Lysis of adhesions coding will depend on the site being freed up (bowel, omentum/abdominal/peritoneal, or ovary/fallopian tubes), the extent of the adhesions, and which additional procedures might be reported at the same surgery. I have not found there are any conflicting opinions of use of these codes.
If the adhesions are hampering the ovaries and tubes you go with 58660. Per the CPT Assistant (Q&A December 2011): ...while code 58660, Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure), involves endoscopic inspection and evaluation of the abdomen and pelvis, it represents uterine adnexal (ie, fallopian tubes, ovaries functionally and structurally adjacent to the uterus), adhesiolysis of any degree performed by any method. Code 58660 may be reported in addition to the primary procedure, only if dense/extensive adhesions are encountered that require effort beyond that which is ordinarily provided for the laparoscopic procedure. As code 58660 is designated as a separate procedure, modifier 59, Distinct Procedural Service, should be appended to indicate that code 58660 is not considered an integral component of the other procedure(s).
In this same Q&A they further state: There is no specific CPT code for laparoscopic lysis of omental/abdominal adhesions. Because adhesions may complicate the successful performance of the laparoscopic procedure, lysis of adhesions is often the first the exploration and may not be coded separately. If the adhesions are extensive and take significant additional work, code 49329, Unlisted laparoscopy procedure, abdomen, peritoneum and omentum, may be reported in addition to the primary procedure. Documentation must reflect the additional work required for the removal (lysis) of dense adhesions.
You should note that there is no CPT code for an open abdominal removal of omental, peritoneal or abdominal adhesions and therefore if this was extensive work and reportable during say a TAH/BSO, I would add a modifier -22 to the base code rather than using an unlisted code because there is no unlisted code that represents an open approach that matches 49329.
If the adhesions are being removed from the bowel (bowel to bowel, bowel to omentum, bowel to peritoneum, bowel to abdominal wall) you go with one of 2 different codes depending on the surgical approach. The codes 44005 and 44180 deal only with the removal of adhesions from the intestines, not omental, abdominal or peritoneal adhesions. If the adhesions are removed to get to the operative site and are not documented as extensive, you don't code for them at all. If the adhesions are removed from a different area from the other procedure and not related to it, or are very extensive you can bill the appropriate code that describes the type of adhesions targeted via the approach documented (open or laparoscopic).
However, CCI bundles all 3 of the specific lysis codes most of time with other surgeries simply because they are labeled as a 'separate procedure' in CPT. In many of those instances, the CCI edit does not permit a modifier -59 to be used to bypass the edit (as recommended by CPT) so your only option in that case may be to use a modifier -22. But only if the documentation clearly shows the extensive additional work performed. Statement like "lysed dense adhesions on omentum/bowel/ovaries" would not be sufficient in my book as it does not fully describe the additional work both in time, risk and effort.
