I'll take a crack at this for you, but there are probably multiple ways that this could be coded. Also, you should check to see what payer-specific guidelines may exist with regard to multiple procedures through the hystero- and laparoscopes.
Keep in mind, that 58660 is ALWAYS included in 58661 and 58662. The op note states that surg had to lyse some adhesions in order to reach the operative site on the tubes/ovaries. Most payers will not pay extra for this. If lysis of dense anatomy-distorting adhesions are required and the dictation clearly states the amount of extra work that was required (usually in extra time spent and/or detailed descriptions), then you could ask for extra money and add modifer 22. This dictation doesn't clearly document the amount of extra work involved, nor does it describe the adhesions as dense or state the extent of the extra work required. The -22 seems kind of iffy to me on this one. Lysis IS separately reportable if it is at a separate site from the primary procedure, but in this case it looks like your doc didn't attemtpt the other adhesions but called in a general surgeon.
CPT has designated 58661 as UNILATERAL (though Medicare has NOT), so, in theory, you could add -50. Two different sides - rt ov and lt tube.
As for the hysteroscopy you could report 58559 and 58558-51. 59559 for the uterine synechiae has higher RVS than 58558 and so would be listed first.
Chromopertubation, when done to check the surgeons work is not separately reportable.
Hope this helps
- ICD-10 Training
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join