Coding Lysis of Adhesions
Lysis of adhesions might be billed separately, depending on the time and effort involved.
CPT(R) includes a number of codes which are for lysis of adhesions categorized by location.
For example:
? Tubes and ovaries, 58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) or 58740 Lysis of adhesions (salpingolysis, ovariolysis)
? Urethral 53500 Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring)
? Intestinal adhesions 44005 Enterolysis (freeing of intestinal adhesion) (separate procedure) or 44180Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)
The additional work can be reported by appending modifier 22, if the surgeon spends significant time performing lysis of adhesions, but cannot find a CPT(R) code specific to the anatomic location.
Documentation is crucial whether one reports a separate CPT(R) code or add modifier 22 to the primary procedure code as the surgeon must give a clear picture describing the difficulty encountered in the procedure.
For example, documentation must include the following points
? Did the adhesions distort the anatomy?
? Were they dense and fibrous?
? How much time was spent in removing the adhesions before viewing the surgical field?
The documentation must establish that lysis of adhesions was unusually complicated and time consuming, for a given procedure.