Converting To Open/seperate Proced

MICHELLE1279

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I need help with coding this surgery. Laparoscopic lysis of adhesions, laparotmy, right salpingo oophorectomy. The physician completed the laparoscopic lysis of adhesions, and was going to do a salpingo oophorectomy laparoscopically, but encountered bleeding, and a developing hematoma, attempts to control w/LigaSure unsuccessfuls, therefore converted to laparotomy, removed the ovary and tube using LigaSure. I coded as sepearte procedures, 58720 dx 789.01, 58660/59 dx 614.6. We are being denied the 58660, being included in the primary procedure. I will send in appeal with notes, but does this coding seem correct? Thanks
 

Treetoad

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Unless the adhesions are "extensive" and require extra time or work to remove, the lysis would be included in the main procedure. It wouldn't matter if the procedure was originally started as laparoscopic and converted to open. Also, the additional effort on the provider's part would need to be justified in the documentation.
 

adwood68

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I would code your scenario this way 58720 789.01, 614.6, V64.41 (laparoscopic procedure converted to open procedure). You can add 22 modifier if your provider appropriately documents that the adhesions are extensive and require extra work. 58660 is a separate procedure.
 

ware

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I need help with coding this surgery. Laparoscopic lysis of adhesions, laparotmy, right salpingo oophorectomy. The physician completed the laparoscopic lysis of adhesions, and was going to do a salpingo oophorectomy laparoscopically, but encountered bleeding, and a developing hematoma, attempts to control w/LigaSure unsuccessfuls, therefore converted to laparotomy, removed the ovary and tube using LigaSure. I coded as sepearte procedures, 58720 dx 789.01, 58660/59 dx 614.6. We are being denied the 58660, being included in the primary procedure. I will send in appeal with notes, but does this coding seem correct? Thanks
You should have coded 58661 with a modifier with modifier 53 and then bill 58720 with a modifier 59 this would be proper coding indicating you started procudure one way but had to end up doing it another way because of complication for the patient well being. Also should have put a code for the Ovary and tubes what ever the path report had, with the 58720. Kware
 

Anastasia

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READING PA
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I agree that both procedures are billable since only the laparoscopy was scheduled & the physician had to do an open procedure after visualizing the pelvis. Use modifiers & appeal.
 
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