Diagnostic Laparoscopy and Lysis Adhesions

Canton, IL
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I am looking for direction to properly code Diagnostic Laparoscopy and Lysis of adhesions. The preoperative diagnosis is pelvic pain. The postoperative diagnosis is bowel adhesions. The physician is OB-GYN. The procedure is started and while the surgeon is there he encounters bowel adhesions. I know that it can't be charged as 49320 and 44180 for any reason, but if lysis of these adhesions are done can the main procedure now become lysis of bowel adhesions with these dianosis. I need solid direction if the physician can't charge this, so I can address the situation. I thought of possibly changing the procedure code to 58660, but even with that I am questioning myself.
Thanks for any help


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Laparoscopy w/lysis of adhesions

I work for a reproductive endocrinologist and he does these all the time, so we're pretty used to coding them.
Okay, first of all, exactly what does he mean by bowel adhesions. What I mean is, exactly where did he see the adhesions. If it's in the pelvic peritoneum (peritubal or tubo-ovarian), which it probably is, then your ICD-9 code is 614.6 (pelvic adhesive disease). Otherwise, you might have to look at 614.7 or .8, but the insurance will probably ask for the op report because they are rather unspecified. I would also include the pelvic pain (625.9) because he is treating that.
As far as the CPT code is concerned, you have two options and it kind of depends upon where the adhesions were as well. Look at 58660 and
58662. If the lesions are around the ovary, pelvic viscera, or peritoneal surface, then use the 58662, otherwise go with the 58660. The RVU is a little higher for the 58662, but not much.
You might need to have your doc do an addendum to the op report that makes things a bit clearer.
If you have an '09 coding companion for OB/GYN, it has some really great explanations for these procedures.