Wiki Coding Lysis of Adhesions CPT 58740

Mmawad

Guest
Messages
22
Best answers
0
Greetings,

I am inquiring about a CPT code for Lysis of Adhesions. I have been getting an issue with Blue Cross Blue Shield of Illinois when I billed the following codes:

58740
58720 (Salingo-oophorectomy) M 59
58563 (Laparoscopy with endometrial ablation) M 59

The payor processed CPT code 58720 as the primary code, however I did not send the claim in this way. Is there something I am missing?
I had another case very similar where the CPT 58740 was billed as the primary code with CPT code 58700 with a modifier 59.

Both cases I was informed CPT code 58740 was bundling against itself, which doesn't make any sense.

Any advise in these cases would be of a great help!

Thank you!
Mark A. (COBCG CPC expected completion Aug 2019)
 
Lysis of adhesions is bundled into 58720. It would also not be the primary procedure since its RVU is lowest of the three codes.
 
Hello Mmawad,

There is a CCI conflict when CPT 58720 and 58740 are billed together and a modifier is not allowed to override the edit. The lysis of adhesions is not separately billable in these situations so you will need to send a corrected claim with only 58563 and 58720-59.
 
Thank you both for the information. As someone who is in training, how did you you know this information. I don't see it in the CPT book. Is there a tool that you use?
Thanks!
 
Thank you both for the information. As someone who is in training, how did you you know this information. I don't see it in the CPT book. Is there a tool that you use?
Thanks!

My encoder subscription has a tool where i can enter the codes and it tells me if NCCI edit exists and shows me the RVUs

I like to read the NCCI manual as well as it has some rationales on common edits but doesn't cover everything.
2019 version is the second link in the downloads section of the following page:

https://www.cms.gov/Medicare/Coding...ndex.html?redirect=/NationalCorrectcodInitED/

The 5XXXX series chapter only speaks of the laproscopic lysis of adhesions codes. The general coding guidelines has a general comment of what is included in all surgical procedures and states the cant include all examples in other chapters for space reasons.

Some services are integral to large numbers of procedures. Other services are integral to a more limited number of procedures.

Examples of services integral to a large number of procedures include:
- Cleansing, shaving and prepping of skin
- Draping and positioning of patient
- Insertion of intravenous access for medication administration
- Insertion of urinary catheter
- Sedative administration by the physician performing
a procedure (see Chapter II, Anesthesia Services)
- Local, topical or regional anesthesia administered by the physician performing the procedure
- Surgical approach including identification of anatomical landmarks, incision, evaluation of the surgical field, debridement of traumatized tissue, lysis of adhesions, and isolation of structures limiting access to the surgical field such as bone, blood vessels, nerve, and muscles including stimulation for identification or monitoring
- Surgical cultures
- Wound irrigation
- Insertion and removal of drains, suction devices, and pumps into same site
- Surgical closure and dressings
- Application, management, and removal of postoperative dressings and analgesic devices (peri-incisional)
- Application of TENS unit
- Institution of Patient Controlled Anesthesia
- Preoperative, intraoperative and postoperative documentation, including photographs, drawings, dictation, or transcription as necessary to document the services provided
- Surgical supplies, except for specific situations where CMS policy permits separate payment

Although other chapters in this Manual further address issues related to the standards of medical/surgical practice for the procedures covered by that chapter, it is not possible because of space limitations to discuss all NCCI PTP edits based on the principle of the standards of medical/surgical practice.
 
Top