Wiki Lap. Right Salpingo-oophorectomy w/ mini laparotomy

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Good morning,
I am hoping to get some clarity on the correct code for Laparoscopic Right Salpingo-oophorectomy w/ mini laparotomy. Total- 6cm long incision was made in order to remove the specimen. (Cyst was 12cm) A 15cm bag was used. From what I can tell the code would probably be 58661, but a lot of work was done besides just a straight forward 58661. It wasn't exactly a 49000.
My doctor also used a thunder beat to cut along adhesions to separate the ovary. Then a piece of plastic from the bag was noted in the pelvis, but it sounds that was easily removed.
Should I used modifier 25 to show there was extra work done?
Thank you for your time.
 
Hi, it really depends on how much extra work was involved, and the provider should have a mod 22 statement. If you look at the coding tip for 58660 (lysis of adhesions) it says,
"The lysis of adhesions to get to the operative field to perform a surgery is integral to all surgical procedures when adhesions exist. Only when the provider performs this lysis as a standalone procedure should you report this code. If the provider documents extensive lysis of adhesions not related to establishing the operative field, and the documentation supports significant work, an option is to add modifier 22, Increased procedural service, to the primary surgical procedure. Documentation will need to include the location of the adhesions, the work the provider takes to remove them, and the additional operative time.""

As for the mini lap, I believe you can add the mod 22; although at my organization, we do not automatically add.
 
When a mini-laparotomy is done only to remove the specimen, it does not change the coding. As the surgery was performed laparoscopic, it is still coded that way.
The lysis of adhesions (58660) is an NCCI edit bundle into 58661.
The piece of plastic removed should not be billed for (no matter how complicated it was) as the provider is the one who caused the plastic to be there.
The modifier I think you mean is -22 for increased procedural services, not -25. -22 is a judgement call. The documentation should indicate substantial additional work. 5 minutes of LOA would not warrant -22. An hour of LOA would.
I like Noridian's concise information about -22 https://med.noridianmedicare.com/web/jeb/topics/modifiers/22
With the limited information provided, I do not feel -22 is justified.
Hope that helps!
 
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