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mllivers

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Harned, KY
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Operative laparoscopy with lysis of omental adhesions and removal of posterior cul-de-sac mass. Would this be coded as 44180 or 58661?

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I don't think either.
44180 is laparoscopic enterolysis - lysis of intestinal adhesions, not omental adhesions
58661 is laparoscopic removal of adnexa (tubes and/or ovaries)
It MIGHT be 58662 - laparoscopic excision of lesions of ovary, pelvic viscera or peritoneal surface
If the procedure is more closely described as a laparoscopic version of 49203-49205 Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors, then you would use unlisted 49329.
In general, the omental adhesions are incidental/included in the primary procedure. If there was significant time/skill/complexity (and documented as such), you could consider -22 on the primary procedure code.
 
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