CPT Codes For Lysis Of Adhesions (2022) – Descriptions, Guidelines, Reimbursement, Modifiers & Examples
CPT code for lysis of adhesions are included in this article. Lysis of adhesions indicates freeing/eliminating scar tissue. All surgical procedures require the hands of a surgeon to perform a careful evaluation of the general surgical site. Therefore, they must accurately visualize the surgical site’s anatomic structures and areas.
CPT Code For Lysis Of Adhesions Description
The Global Surgical Package consists of all procedures necessary to ensure sufficient access to the surgical site and surrounding areas.
For example, suppose it is required to excise excessive tissue, implanted material, or remove adhesions (scar tissue) to perform the procedure.
In that case, these additional services are generally considered inclusive in payment for the global surgical service. However, in some cases, the actual work performed to obtain adequate visualization takes longer than the surgical procedure.
The pelvic adhesions are bands of collagenous scar tissue that can develop in the abdomen and pelvis after surgery or due to infection.
Because adhesions connect organs and tissue that generally are separated, they can lead to various complications, including pelvic pain, infertility, and bowel obstruction.
Adhesions usually form on the ovaries, pelvic sidewalls, and fallopian tubes.
Although obstetrics and gynecology are usually concerned with adhesions lysis in only four sites, the CPT manual provides six codes for the associated procedures:
CPT 44005 describes the freeing of intestinal adhesions and counts as a separate operation. The global period is 90 – days.
CPT 56441 narrates the labial adhesions lysis. The global period is 10 – days.
CPT 58559 narrates the hysteroscopy; intrauterine adhesions lysis. It is a surgical technique. (Any procedure).
CPT 58660 narrates the laparoscopy with lysis of fallopian tubes and ovaries adhesions; It is a surgical technique and counts as a separate operation. The global period is 90 – days.
CPT 58740 narrates the lysis of adhesions of fallopian tubes or ovaries. The global period comprises 90 – days.
CPT 44180 narrates the laparoscopy; intestinal adhesion free. It is a surgical technique and counts as a separate procedure. The global period is 90 – days.
CPT Code For Lysis Of Adhesions Billing Guidelines
Generally, the coder should separately report adhesiolysis in only two situations when performed with another procedure:
- The lysis of adhesions is substantial
- The adhesions are in another anatomic site from the primary service.
Suppose the OR report contains specific documentation indicating that the services are substantially more valuable than typically required for a similar procedure. In that case, the coder or biller can add a modifier 22 to the primary procedure code.
The documentation must bear that the work performed is substantially more excellent than commonly required and the reason behind doing it.
This documentation should indicate that the provider needed an increase in intensity, time, the severity of the patient’s condition, or substantially more work, time, or physical or mental effort than similar procedures.
When a clinician executes an independent (medically diagnosed) lysis of adhesion of the fallopian tube, ovaries, or intestines as an ultimate procedure, it would be accurate to outline the process as indicated (CPT 44005, CPT 44180, or CPT 58660) with the appropriate diagnosis.
Commercial payers may consider providing additional reimbursement to both the surgeon and assistant surgeon, depending on the documentation in the OR report. That documentation must specify the additional time required and the specific nature of the extra work performed.
There must be thorough documentation in the patient operative report that identifies, at a minimum, the indication, process, and outcome particular to the lysis procedure. In addition, they can incorporate supporting documentation for the primary/definitive surgical procedure.
However, it must be identifiable, by the reader, as distinct and separate from the primary operation. For example, the coder or biller often includes lysis of adhesions in the prime surgery, but the physician can get paid separately if the adhesions are extensive.
Suppose the adhesions lysis is extensive and bundled into the primary procedure by the National Correct Coding Initiative or some other bundling software. In that illustration, the coder should add modifier 22 (Unusual procedural services) to the primary procedure code.
Otherwise, he should report extensive adhesiolysis separately.
The documentation must support the primary ICD 10 CM code because it refers to the logic behind accomplishing an operation. If more than one CPT codes are there, the prime diagnosis code must back the primary procedure.
The following tips may assist in reporting lysis of adhesions separately.
When determining whether the coder or biller should be coding adhesiolysis in addition to the primary procedure, he first has to examine the ob-gyn’s documentation.
Insurance companies usually don’t reimburse separately for eliminating soft filmy adhesions by blunt dissection when the physician performs the lysis with other procedures.
The documentation must describe the significant work associated with the removal (using sharp dissection and sometimes laser) of adhesions that are very adhesive and have a blood supply.
The next major step is to establish where the surgeon lysed the adhesions to determine which code to choose. For instance, if the ob-gyn performed adhesiolysis of the bowel, the coder must report CPT 44005 depending on the approach.
However, if the physician has lysed pelvic adhesions, the coder should submit CPT 58660 or CPT 58740, depending on the exact location of the adhesion if appropriate.
Sometimes, an ob-gyn attempts a procedure laparoscopically, but the physician must change to an open approach to complete the surgery because of extensive adhesions.
They bundle the laparoscopy into the Open Procedure under the rules of Medicare and many Medicare following payers, so the coder cannot report it separately. The only option is to note the primary surgery appended with modifier 22.
Suppose the ob-gyn surgeon inserts the laparoscope aiming to employ a transvaginal sling. Upon inserting the scope, he finds extensive adhesions on the left side of the bowel, adhering the bowel to the pelvic sidewall and the left tube and ovary.
The right side is even poorer. After attempting to free the adhesions for an hour with little success, the physician decides to convert to a laparotomy to finish the practice.
Because the surgeon took additional time to execute the procedure laparoscopically, the coder should report CPT 57288 – 22 (sling procedure for stress incontinence, e.g., fascia or synthetic). The quantification of the additional time and effort in the documentation is crucial for reimbursement purposes.
In addition to describing the time in the procedure, sometimes the note includes a cover letter that contrasts the additional time and effort with the average time and effort the operation usually takes to perform.
Reimbursement
The CMS has provided the physician fee schedule for facility and non-facility. Usually, the commercial payers follow the reimbursement policy of Government payers (Medicare or Medicaid). But the prices for specific CPT codes may differ slightly for commercial payers.
The Physician Fee Schedule for CPT 44005 is $ 1126.43 for facility and non-facility.
The Physician Fee Schedule for CPT 56441 is $ 191.72 for non-facility, and the Physician Fee Schedule is $ 159.54 for the facility.
The Physician Fee Schedule for CPT 58559 is $ 290.69 for facility and non-facility.
The Physician Fee Schedule for CPT 58660 is $ 702.51 for facility and non-facility.
The Physician Fee Schedule for CPT 58740 is $ 928.83 for facility and non-facility.
The Physician Fee Schedule for CPT 44180 is $ 949.25 for facility and non-facility.
CPT Code For Lysis Of Adhesions Modifiers
When a clinician spots adhesions in a location other than the specific field of surgery for the primary/definitive procedure and indicates their removal medically, the clinician may announce this event by submitting an additional procedure code added with modifier 59 to the claim for the primary/definitive procedure.
When the surgeon does not indicate a definitive lysis surgical procedure, he confronts extensive/dense adhesions that are difficult to remove (needing 30 minutes or more of OR time). He may report this situation by appending a 22 modifier to the primary/ surgical CPT code.
They must incorporate documentation required to support a 22 modifier into the operative report. For example, it must identify the extensive nature of the adhesions and document the additional time in minutes required, specifically for adhesiolysis.
Example
The following scenarios are examples where a provider can consider additional reimbursement.
- The ob-gyn documents that the physician lysed intestinal and pelvic adhesions while performing abdominal surgery, and the adhesions were dense, anatomy-distorting. As a result, the physician took a long time to lyse.
In this manifestation, the coder may be able to report both CPT 44005 and CPT 58740 and the primary surgical procedure code because the adhesions were extensive and required significant time to lyse.
- Suppose the surgeon notes encountering dense adhesions involving the bowel and omentum during a laparotomy. That encounter may require two hours of adhesiolysis to adequately expose the uterus and pelvis. That helped to execute a Hysterectomy.
Based on this information, the coder may report CPT code 44005 and CPT code 58150 (described as the total hysterectomy of the abdomen [corpus and cervix] with or without tube elimination and with or without ovary removal).
But the NCCI bundles CPT 44005 into CPT 58150 with a “0” modifier indicator signifying no modifier can override the edit. Therefore, the coder should report the additional work involved with the extensive adhesiolysis by appending Modifier 22 to CPT 58150.
