How To Use CPT Code 58660

CPT 58660 is a laparoscopic surgical procedure for the removal of adhesions around the fallopian tubes and ovaries. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 58660 procedures.

1. What is CPT 58660?

CPT 58660 is a surgical procedure that involves the removal of adhesions that have formed around the fallopian tubes and ovaries using a laparoscope. This code is used when the lysis of adhesions is performed as a standalone procedure and not as part of another gynecological surgery.

2. 58660 CPT code description

The official description of CPT code 58660 is: Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure).

3. Procedure

1. The patient is placed in the dorsal lithotomy position, and the abdomen is prepped and draped.
2. General anesthesia is administered.
3. A uterine manipulator is placed through the cervix to move the uterus during the surgery.
4. The provider enters the abdominal cavity near the belly button using a Veress needle or an open incision and places a laparoscope.
5. The abdomen is insufflated with CO2 gas to create a pneumoperitoneum, and the patient is put into the Trendelenburg position.
6. Small incisions are made around the abdominal area to insert trocars for better visualization and insertion of surgical tools.
7. If robotic surgery is being performed, the robot is docked to the laparoscope at this time.
8. The provider inspects the abdominal cavity and identifies the location, shape, and extent of adhesions around the tubes or ovaries.
9. The provider breaks down the scar tissue, or adhesions, using scissors, laser, cauterizing instruments with high-frequency electric current, or other techniques until all adhesions are removed.
10. Chromotubation may be performed to check the openness of the fallopian tubes.
11. The abdominal cavity is irrigated and deflated, and all instruments and trocars are removed.
12. The trocar site fascia and skin are closed, and all instruments are removed from the vagina.

4. Qualifying circumstances

CPT 58660 is appropriate for patients who have adhesions around their fallopian tubes and ovaries that require removal. These adhesions may cause pain, infertility, or other complications. The procedure is typically performed when the adhesions are not related to establishing the operative field for another gynecological surgery. If the adhesions are removed as part of another surgery, CPT 58660 should not be billed separately.

5. When to use CPT code 58660

CPT code 58660 should be used when the lysis of adhesions is performed as a standalone procedure and not as part of another gynecological surgery. If the provider documents extensive lysis of adhesions not related to establishing the operative field, and the documentation supports significant work, an option is to add modifier 22, Increased procedural service, to the primary surgical procedure. In cases where 58660 is not part of a payer bundle, reporting this code with a modifier 59, Distinct procedure, may be appropriate if the documentation warrants reporting this part of the surgery.

6. Documentation requirements

Documentation for CPT 58660 should include the location of the adhesions, the work the provider takes to remove them, and the additional operative time. The provider should also document the patient’s medical history, physical examination, and any diagnostic tests that support the need for the procedure. Additionally, the operative report should detail the steps of the procedure, including the type of anesthesia used, the instruments and techniques employed, and any complications encountered.

7. Billing guidelines

When billing for CPT 58660, it is essential to ensure that the procedure is not bundled with another gynecological surgery. If the lysis of adhesions is performed as part of another surgery, CPT 58660 should not be billed separately. In cases where extensive lysis of adhesions is documented and not related to establishing the operative field, adding modifier 22 to the primary surgical procedure may be appropriate. If 58660 is not part of a payer bundle, reporting this code with a modifier 59 may be warranted if the documentation supports reporting this part of the surgery.

8. Historical information

CPT 58660 was added to the Current Procedural Terminology system on January 1, 2000. There have been no updates to the code since its addition.

9. Similar codes to CPT 58660

• CPT 58661: Laparoscopic removal of adnexal structures, which differentiates from CPT 58660 by including the removal of the adnexal structures in addition to the lysis of adhesions.
• CPT 58662: Laparoscopic fulguration or excision of lesions, which involves the destruction or removal of lesions rather than the lysis of adhesions.
• CPT 58670: Laparoscopic occlusion of fallopian tubes, which focuses on blocking the fallopian tubes rather than removing adhesions.
• CPT 58671: Laparoscopic occlusion of fallopian tubes with devices, which uses devices to block the fallopian tubes instead of removing adhesions.
• CPT 58672: Laparoscopic fimbrioplasty, which involves the repair of the fimbriae of the fallopian tubes rather than the removal of adhesions.

10. Examples

1. A patient with a history of pelvic pain and infertility undergoes CPT 58660 to remove adhesions around her fallopian tubes and ovaries.
2. A patient with a history of endometriosis has CPT 58660 performed to remove adhesions that have formed around her ovaries.
3. A patient with chronic pelvic pain undergoes CPT 58660 to remove adhesions around her fallopian tubes that are causing her discomfort.
4. A patient with a history of pelvic inflammatory disease has CPT 58660 performed to remove adhesions around her fallopian tubes and ovaries.
5. A patient with a history of multiple abdominal surgeries undergoes CPT 58660 to remove adhesions around her fallopian tubes and ovaries that have formed as a result of her previous surgeries.
6. A patient with a history of ectopic pregnancy has CPT 58660 performed to remove adhesions around her fallopian tubes that may be contributing to her fertility issues.
7. A patient with a history of tubal ligation undergoes CPT 58660 to remove adhesions around her fallopian tubes that have formed as a result of the procedure.
8. A patient with a history of ovarian cysts has CPT 58660 performed to remove adhesions around her ovaries that have formed as a result of the cysts.
9. A patient with a history of pelvic adhesions undergoes CPT 58660 to remove adhesions around her fallopian tubes and ovaries that are causing her pain and discomfort.
10. A patient with a history of prior gynecological surgeries has CPT 58660 performed to remove adhesions around her fallopian tubes and ovaries that have formed as a result of the surgeries.