# Coding for LSO and Extensive Enterolysis



## cmedsolutions@yahoo.com (Nov 19, 2013)

Can anyone confirm, or add to,  the following coding question? 

Procedure Performed: Robotic assisted left salpingo-oophorectomy and right salpingectomy as well as extensive enterolysis.   CCI says 44180 is bundled into 58661 and can never be billed together, and since 58661 is a unilateral procedure there is no need to specify the RT/LT for one side tube and ovary and the other side tube only.  My only option to get this doctor paid for time spent on removal of bowel adhesions is to code 58661 with modifier 22 and send the OP notes with the HCFA...?????    

Sincerely, 
Cindy S.


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## elpatrick (Nov 20, 2013)

*Modifier*

If the op notes states it was a distinctive difference between the two procedures try billing with a 59 modifier.


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## dlashua (Nov 20, 2013)

This is a bundled procedure so the use of mod 59 would not be appropriate.  I would append modifier 22 and send the notes.


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## cmedsolutions@yahoo.com (Nov 21, 2013)

*Mod 22*

Okay...so your recommendation is 58661 (only) with mod 22 and op notes, yes?


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## cmedsolutions@yahoo.com (Feb 14, 2014)

*HELP! 58660 Vs 44180 Entterolysis 02/14/2014*

Operative Report Reads:

The facscia was elevated and we entered directly and there we put in a Hasson type cannula with a balloon on the end and filled the abdomen with CO2. We looked in the pelvis and revealed that the cul-de-sac was completely obliterated with numerous adhesions.  The appendix was noted to be4 normal. We then made a suprapubic puncture site as well as one in the left lower quadrant and there we elevated the uterus and lysed adhesions and mobilized the fallopian tubes.  Prior to that , we did hydrochromotubation to no avail and no dye appeared in the bues but the dye did not exit the tubes.  We then continued to lyse the adhesions and mobilize the right ovary completely.  The left ovary we could not completely mobilize, but we released all the adhesions in the cul-de-sac.  At this point , we felt that she was going to have an in vitro fertilization pregnancy.  We got the adhesions controlled. We were able to mobilize both fallopian tubes and mobilize the right ovary, but the left ovary we could not mobilize out the cul-de-sac.  It was attached to the bowel and therefore we did not want to take any risks by trying to separate that away with the bowel being so closely approximated to it and using cautery.  


The physician dictates this as a "Extensive enterolysis" procedure.  However, I would NOT code this as 44180 since the wording in dictation clearly states "lysis of adhesions from tubes and ovaries and pelvic/cul-de-sac".   

Would it be correct to code this as 58660 (poss mod 22)??????


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