Wiki How would you code a Total Laparoscopic hysterectomy, bilateral salpingectomy. With extensive lysis of Adhesion s before surgeon could even start the

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How would you code a Total Laparoscopic hysterectomy, bilateral salpingectomy. With extensive lysis of Adhesion s before surgeon could even start the hysterectomy. Need help.
 
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Lysis of adhesions is bundled into a laparoscopic hysterectomy. If the op note justifies it, you could consider modifier -22. The op note should clearly indicate what was unusual to make it substantially additional work. The claim will typically be pended for additional documentation. You would then send the op note along with a letter summarizing and specifying what you are asking for (10% increase, 20% increase, which should be customized to the amount of increased work done in the specific situation).
My local MAC has the following policy about -22:

Modifier 22 – Increased Procedural Service​

Modifier 22 is used to identify procedures which require individual consideration and should not be subject to the automated claims process. A description of the increased services may be entered in the comments field of electronically billed claims, or submitted as an attachment with paper claims. NGS may require additional documentation to support the substantial additional work (for example, increased intensity, time, technical difficulty of the procedure, severity of the patient’s condition, and physical/mental effort required). Documentation includes, but is not limited to, descriptive statements identifying the increased services, operative reports, pathology reports, progress notes, office notes, etc. If additional information is needed, we will request it.

The submission of a procedure with modifier 22 does not ensure coverage or additional payment. All claims with modifier 22 and appropriate documentation are reviewed by medical review staff to determine whether payment is justified.

Modifier 22 can be used on all procedure codes with a global period of 1, 10 or 90 days when unusual circumstances warrant consideration of payment in excess of the fee schedule allowance.
 
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58572 description is Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250g
I obviously can't tell from this op note if the uterus did in fact weigh >250gms, but seems reasonable as it was 18 week size and multiple myomas. This patient also had a bilateral salpingectomy, which is I think where you are going wrong. If the uterus was > 250gm, the correct code would be 58573 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s). Since the op note specified over an hour (more specific like 75 minutes, etc would be better, but it is at least an hour) for lysis of adhesions, that to me justifies -22.
58573-22 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)again, assuming uterus was >250gms
or
58571-22 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) if uterus was not >250gms.
I recommend confirming with the pathology report.
 
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