Reporting 58661 vs. 44005

Billing500

Networker
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Hi AAPCers,
My provider performed:
  • D&C (58559)
  • Right salpingo-oophorectomy (58661)
  • Laparoscopic Enterolysis [separate procedure] (44005)
The D&C is a straight shot. However since the Enterolysis code has a higher work RVU, should it be billed instead of 58661? Alternatively, I've read that some providers are billing 58661 w/ a 22 modifier for additional work with op notes(instead of 44005.)

Does anyone have experience with submitting these particular codes and reimbursement experience relating to same?

Thank you!
 

Bready

Guru
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58661 vs 44005

I believe the rule of thumb is that if the surgeon has to remove adhesions to get to the area he needs then it is included in the procedure(58661) UNLESS he has documented that the adhesions were exceptionally dense/intrusive and took an extraordinary amount of time eg: "30 additional minutes were added to this procedure due to extensive lysis of adhesions". So, I would agree with those who are adding the modifier 22 to 58661 and attaching the op report. You would not bill the enterolysis instead of the 58661 ( the patient was scheduled for a D&C and salpingo-oopherectomy and the enterolysis was needed to do the above) I hope this makes sense.
 
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