|May 2003 · Vol. 15, No. 5
Adhesions and ovarian excrescenceMELANIE
RN, CPC, MA
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.
Q For laparoscopy with lysis of adhesions, peritoneal washings, peritoneal biopsies, and left ovarian excrescence removal for biopsy, should I use code 58662?
A Code 58662 (laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method) would cover the removal of the left ovarian excrescences, but does not capture the lysis of adhesions. Many payers bundle this procedure because they believe it is incidental. However, if the adhesions were extensive and the extra time the physician spent in removing them is well documented, you can either bill the lysis separately using code 58660-59-51 (to indicate it was a distinct, multiple procedure) or you can add modifier -22 (unusual procedure) to code 58662 to indicate extensive additional work. Note that you would only use this latter option for payers you know always bundle lysis of adhesions when billed separately (Medicare, for example).