# Exp. Laparotomy & bso



## bgrenfell (Aug 10, 2010)

My doc is an ob/gyn and he performed an Exploratory Laparotomy with a BSO and Lysis of Adhesions and Washings of adhesions.  Can I bill for the Exp. Lap and the BSO, or is this considered bundling?  I appreciate any help.


----------



## cmcgarry (Aug 10, 2010)

This would be unbundling - an exploratory laparotomy is not billed once a definitive procedure is performed.


----------



## preserene (Aug 12, 2010)

Then shall we assign 58720 append  modifier-59 for adhesiolysis and modifier -22 for increased  procedural services (since exploratory laparotomy involves exploration (bieng  the first intention of the surgery)complex, demanding time, efforts and physical and mental work,eg explore for lymphnodes or other organ status or some coexisting pahtology.
I wish I could get the feed back for this query of modifer addendation.


----------



## mitchellde (Aug 12, 2010)

unless the lysis of adhesions is extensive and documeted as having therapeutic value to the patient, rather than to clear the way for the physician, you cannot bill anything additional.  Adhesions are normal and most surgeons must take down the adhesions as a part of the surgical service.   To use the 22 modifer you will need really great docuemntation to support that the procedure was more intensive and involved than what it should have been.  Just having started as an exploratory that becomes a definitive procedure in not enough.


----------



## preserene (Aug 12, 2010)

Yes, indeed I understand. But the adhesions in pelvic region and the crowding anatomy and the histological structures of all those surrrounding uterine adenexal region are proned for complex and incarcerated adhesions with prevalence of infections  in those structures; for eg appendecitis, PIDS, salpingitis, pelvic peritonitis and so on. Some of them pass unnoticed even.
One story about a surgery that took place in one of Middle East countries:  a famous Consultant Surgeon was given a verdict for getting his testes removed, just because of a few ovarian tissues just seen on a cyto path study of the appendectomy specimen. This  is just to be aware of extent of the impact of adhesiolysis in those areas .
I can agree with filmy flimsy adhesion like in skin area or vulval adhesion due to infection as trivial ones.
Well, as you said if the doctor documents the extent of the procedures  then it can be.
Thank you


----------

