Wiki I'm officially stumped!

[Jessim929]

I hope someone can shed a little light or at least point me in a direction on this case.

Two of my Urologists also do Uro/Gyn, and in this case, one of them was called in to a Gyn's case - she was doing a myometrium repair and found dense abdominal adhesions from the cervix and uterus to the bladder dome and posterior wall. He used Metzembaum scissors to dissect and lyse all the adhesions off the bladder.

I am having a heck of a time finding a suitable code. It was an open procedure, so that rules out all laparoscopic codes. 44005 doesn't fit because it wasn't intestinal. The only other option I can think of is the solo E&M code, because he did dictate a full intra-op consult.

Anyone have any insight?

Thank you!!!

 

[csperoni]

NOT just an E&M. I definitely would not use just an E&M as the service performed would be grossly undervalued.
The only open lysis of adhesions codes are:
44005 Enterolysis (freeing of intestinal adhesion)
58740 Lysis of adhesions (salpingolysis, ovariolysis)
You specify the adhesions were bladder/cervix/uterus, which doesn't really fit either of the above. I would query the provider or read carefully through the op report to confirm there were not adhesions involving the ovaries/fallopian tubes. It would seem odd to me that there were extensive adhesions involving the uterus, but not the tubes/ovaries. If there were, then 58740 is your code. If not, I would use unlisted 58999 and compare value to 58740.

 

[Jessim929]

I agree the solo E&M was undervaluing the service. That's why I was feeling so stuck. I am going to query him further to see if the tubes/ovaries were involved. If it was minimal, then a 52 mod would be appropriate, yes?

Thank you soooo much!!

 

[csperoni]

Yes, especially if your doc didn't open or close (that was likely done by the primary doc who encountered the adhesions), then -52 is very appropriate.

 

[Jessim929]

Thank you so much for all your help! I'm up to the "hurry up and wait for the answer" portion!