# Laparoscopic lysis of pelvic adhesions



## burnam (May 18, 2011)

I have a question regarding coding of lap. lysis of pelvic adhesions:


Our physicians' dictation states as follows (I am only putting the information pertinant to the procedure):
Preop Diagnosis: 
Pelvic pain, dyspareunia, probable pelvic adhesive disease & failed medical management
Postop Diagnosis:
Same with severe pelvic and abdomial adhesions, resolved
Procedure performed:
Operative laparoscopy
LigaSure ligation of pelvic and abdominal adhesions

Op Findings: Anterior abdominal wall to omental adhesions over the entire anterior abdominal wall area adn cholecystectomy scar area of the anterior abdominal wall and right upper quadrant.  There were left adnexal adhesions and posterior cul-de-sac adhesions, now 90 percent improved.

Procedure:  Patient brought to OR, prepped and drapped in dorsal lithotomy position.  All supplies for lap procedure were placed. Ligasure ligation was done to take the anterior abdominal wall to omental adhesions down without bowel damage or major blood vessel damage.  once the lower anterior pelvic abdominal wall could be seen safely, a 5 mm suprapubic trocar was placed under direct visualization.  There was no bladder or bowel damage noted. Futher adhesions were taken down inferior to this all the way to the posterior cul-de-sac which there was a small amount of adhesions involving this area but mostly the vaginal cuff was freely mobile.  At that time, the right upper quadrant adhesions were taken down using ligasure with no liver or vital organ damage noted.  All trocars were removed, etc for completion of procedure.........


I would like to know how other coders would code this procedure? Our hospital is coding it as an unlisted laparoscopic procedure and having trouble getting it paid.  I have always been informed to code these as 58660, but would like to know which is the correct way to code.

Thank you in advance.


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## surgonc87 (May 18, 2011)

I would use 44180 or 58660. Depending on documentation, nature of and better reporting for RVU purpose when it comes down to either or.

-based on documentation you've provided

MS


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## burnam (May 19, 2011)

Thank you so much for the clarification. the hospital coders are wanting to use code 49329 and I just hate using that code when the physician is adamant that it is 58660.


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