Wiki CPT CODE 58661 with modifier 22

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rockylopez

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Hello Coders. I have a diagnostic laparoscopy converted to mini lap. I believe the cpt code is 58661 and with the extensive lysis of adhesions modifier 22 is supported. Any input is appreciated.

Thank you.

"During evaluation, the contents of the left and right ovarian cyst were spilled, revealing a chocolate cyst. Adhesions were noted and manipulation of the uterus and adnexa was difficult and thus the decision to open was made."

Operative findings:
1. 4cm upper posterior subserosal fibroid.
2. Bilateral 4 cm endometriomas. No evidence of torsion of the right ovary.
3. Left hydosalpinx
4. Moderate adhesions of the left hydrosalpix to the sidewall.
Complications: Conversion from laparoscpy to laparotomy

Pre-procedure diagnosis:
Suspected right ovarian torsion
Post-procedure diagnosis:
1. Endormetriosis
2. Bilateral endometriomas
3. Left hydrosalpinx
Procedures performed:
1. Diagnostic laparoscopy
2. Conversion to mini-laparotomy
3. Decompression of bilateral endometriomas
4. Lysis of adhesions
5. Left salpingectomy
Technique/Procedure:
laparoscopy with convertion to laparotomy
 
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Thank you for your response. The only reason why I believe 58661 is supported per op report an ovarian cystectomy was not performed. A left salpingectomy was performed for this procedure. I didn’t think cpt 58925 is supported
 
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My apologies! I was confusing the original discussion about a cystectomy and thought this was really just asking the same question again about whether -22 was warranted and/or laparoscopic vs open.
The information you posted here clearly states left salpingectomy. As the surgery was performed open, this would be an open salpingectomy 58700.
 
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csperoni said:
My apologies! I was confusing the original discussion about a cystectomy and thought this was really just asking the same question again about whether -22 was warranted and/or laparoscopic vs open.
The information you posted here clearly states left salpingectomy. As the surgery was performed open, this would be an open salpingectomy 58700.
Click to expand...
Thank you very much.
 
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Hi, just curious if he actually converted to open? He states " Conversion to mini-laparotomy", not "conversion to open" in the list, which seems to conflict with the initial statement. If he only did a mini lap to remove the speciman, I would not code as an open procedure.
 
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Cmama12 said:
Hi, just curious if he actually converted to open? He states " Conversion to mini-laparotomy", not "conversion to open" in the list, which seems to conflict with the initial statement. If he only did a mini lap to remove the speciman, I would not code as an open procedure.
Click to expand...
I definitely agree if it was laparoscopic with just an incision to remove a specimen it would not be coded open. I think that was the other post which I was originally confusing with this one thinking it was the same case. Other post was about whether it was a mini-laparotomy just to remove 12cm cyst and actual surgery was laparoscopic vs the actual surgery was converted to open.
In this post, the documentation states twice (under complications and technique) it was converted to laparotomy. Without seeing the entire note, I would think if the provider states they converted to laparotomy, then they did the surgery open. But this could be a clinician with poor documentation skills. I always read through the entire note when coding, but with the information here, seems to be open. If this was in fact a laparoscopic surgery, I would provide additional guidance to my provider to make documentation clearer.
 
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