# Laparoscopic Appendectomy with lysis of adhesions (salpingolysis)



## TammyFarris (Apr 24, 2009)

Can anyone give me some instructions on billing 44970 and 58660?  It seems like since the surgeon was already in there laparoscopically for the appendectomy that a modifier should be applied to 58660.  If so, which one?  The services aren't bundled, and only one (58660) is an endoscopic code.  Will Medicare pay both at 100% if no modifier is applied?  That doesn't seem right to me. The only thing I can think of is to apply modifier 52.


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## neha.bhatnagar (Apr 27, 2009)

58660 is bundled in 44970 can not be billed together for same date of service. There is no modifier which can be used in such case.
Medicare will just pay for 44970 and deny 58660 stating inclusive in 44970. 

Regards,
Neha Bhatnagar, CPC, CPC-H


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## Anna Weaver (Apr 27, 2009)

*lysis adhesions*

Lysis of adhesions cannot be billed separately, however, if you have extensive adhesions and it's documented as such, then you could add the 22 modifier to your procedure and submit documentation for extra pay. Some carriers will pay more for being more complicated than a simple appendectomy. Some won't. There should be documentation that it required extra time, effort, supplies etc. Some of my docs will now dictate that it took an "extra hour of time as the adhesions were extremely dense" or something of this nature. Must be clearly documented that it took extra time and skill. Sometimes the Doc's just write "adhesions lysed". This doesn't get a 22, it becomes part of the surgery. Even if they say adhesions were extensive, it's not enough to get the 22, but this is controversial.  
Good luck.


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## Lisa Bledsoe (Apr 27, 2009)

I don't show those codes as bundled.  However, 58660 is a "separate procedure" so you could add mod -59 since the lysis of adhesions was performed on the tubes/ovaries - a totally separate location/organ than the appy.  58660 would not be incidental to the completion of the appy...just my thoughts/opinion.


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## TammyFarris (Apr 27, 2009)

Thanks for the reply...can you tell me where you found they were bundled?  I searched the NCCI edits and couldn't find where they are bundled.


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## neha.bhatnagar (Apr 28, 2009)

*Lysis of adhesions*

CPT 58660 & CPT 44970 are bundled. Please check for Flashcode Or Encoderpro software CCI edits for these codes.

Neha Bhatnagar
CPC, CPC-H


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## Anna Weaver (Apr 28, 2009)

*lysis adhesions*



TammyFarris said:


> Thanks for the reply...can you tell me where you found they were bundled?  I searched the NCCI edits and couldn't find where they are bundled.



In the bookrocedural coding professional 2009 put out by AAPC, page 353 the coding guidance states:
Lysis of adhesions should not be reported together with any other surgical laparoscopic procedure.

There are other rules out there and I can tell you some will code the lysis other's won't. I haven't had any luck getting lysis paid so I quit coding unless it was by itself, and started adding the 22 modifier if extensive, leaving it as inclusive if done with another procedure, if they are not. 

It's an individual thing I think, like many things coding, there isn't an easy answer.


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## Zina (Apr 28, 2009)

I agree with Anna Weaver, if your doc will document the extra time in the body of the op report you can bill it with a -22, get the rejection and then appeal with op report and a copy of the OR log that shows the begin and end time of the procedure. You should also reference the amount of time it usually takes to perform the same procedure without the added work of the adhesions. The worst they can do is hold up the denial.


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## TammyFarris (Apr 29, 2009)

Thanks so much for the very helpful info!!!  It appears I need a few more books on my desk!!!


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