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Lysis/fulguration w/c-section

  1. #1
    Default Lysis/fulguration w/c-section
    Medical Coding Books
    While doing a c-section a doctor also did a procedure on the ovary, "lysis of pelvic adhesions and fulguration of endometriotic implants of left ovary" which I believe if he did this by itself would be 49203 however the patient was already opened up for the c-section. How would this be coded. I find 58662 for the procedure but that is a laparoscopy procedure.Thanks

  2. Default
    This is my school of thought to assign:-

    Cesarean section is a comprehensive and an unique service. Emdometrioma an dadhesiolysis are separate lesions of another site/organ.
    Ovarian fulgration and adhesiolysis are not component service of this comprehensive service and it is not an accepted standard of care when performing C-section, nor necessary to complete the comprehensive service.
    It is not a inseparable service to the C-section. For eg, Ovarian fulguration for endometriosis/endometrioma and/or pelvic adhesiolysis are not component code(s) for performing C-section to expose the uterus and bring out the baby. ( Of course there may be some adhesion in previous cesarean sections on the abdominal wall which may need to go for adhesiolysis to expose the uterus, but not pelvic adhesion and lysis for C-surgery ).
    These procedures are separate and distinguishable. I would not say they are incidental, either. C-section a comprehensive and a complex procedure by itself needs lots of attention and risks of its own to be taken care of .If a surgeon does these other procedures means they are to be addressed to reduce the risks of complications and later problems, if left alone unaddressed.

    So, I would rather go for the codes C-section code, 58740 -59, and one from (49203-49205)-59.
    There is no necessity for laparotomy to be reported separately .
    Pertinent and detailed operative notes should be attached as support.
    Hope this helps.
    Thank you.

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