# Adhesiolysis



## Trendale (May 20, 2008)

Can someone help me out with this scenario? A patient had a hysterectomy performed by two surgeons in which I do not code for. The surgeon I do code for, mentioned this in his report. He further stated that surgeons that did the hysterectomy asked for his assistance to perform a adhesiolysis for uterine fibroids, endometriosis. Is this bundled and he should not bill for this?, or do I code the adhesiolysis with a mod 80( assistant surgeon)?, and can you tell me the appropriate code for adhesiolysis. The only one I see is 58559, whis is a hysterscopy. Is there another section I should be in for this code? Your input is greatly appreciated. Thanks!


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## mbort (May 20, 2008)

just my perception, but if your doctor dictated a separate note for his portion of the procedure, then wouldnt it be considered a co-surgery?


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## Trendale (May 20, 2008)

*Adhesiolysis reply*

The only thing with the mod 62, is that both surgeons would report the same code with a mod 62. In this case both surgeons would report the hysterectomy code with 62, but my physician did not perform the hysterectomy, he only did the adhesiolysis, which is why I thought I should use the mod 80  (Surgical assistant services) with the appropriate PX code, unless it is bundled.


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## Treetoad (May 20, 2008)

Since the surgeons didn't share responsibility for a procedure, I don't think I would report it as co-surgeons.  And it doesn't seem to me as if he assisted with the main procedure, so I don't think I would report it as an assist.  I think if I were the coder, I would bill for the adhesiolysis only without a modifier.  Your surgeon acted independently for that procedure.

I hope this helps.

~L


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## Trendale (May 21, 2008)

*adhesiolysis*

Yes, I agree with you after giving it more thought, especially since It is involving different specialties. The only thing, I am not sure of is the appropriate code to use. I have 58740, which involves the ovaries and the tubes, the report says there were a few dense adhesions along the anterior wall of the rectum at the posterior aspect of the uterus and proximal vagina . Any thoughts?


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## Treetoad (May 21, 2008)

How does 44005 sound?


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## Trendale (May 21, 2008)

*Adhesiolysis Reply*

I initially contemplated that as well, but that code is an exception of the rectum, and the adhesions were also along the anterior wall of the rectum as well as the uterus and proximal vagina. since this code (58740) involves the uterus and the dx is uterine fibroids and endometriosis, I believe 58740 is a better code, but if you have any guidelines (eg. CPT Assisatnat etc.), regarding the use of that code(44005), please let me know. I really appreciate you and any others in helping me trouble shoot this, any other suggestions is welcomed. Thanks!


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## Treetoad (May 26, 2008)

I wonder if you could use both 58740 and 44005?  I realize that 44005 is listed as a "separate procedure", but if lysis of adhesions was performed on both organ systems, you could do it if you used modifier 59 on 44005.  What do you think?


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## dkward (Jun 15, 2011)

*adhesiolysis*

Hope this information is helpful to all of you confused about billing adhesions. They have been a thorn in my side for years. This information gives us more coding options. 

Lysis of intestinal adhesions reporting with other intestine codes
CPT Assistant, January 2000 Page: 11 Category: Coding Consultation 

Related Information:  

Surgery Digestive System Intestines (Except Rectum) 

Question  

Is it appropriate to ever report code 44005 with the other intestine codes? If so, under what circumstances? 

AMA Comment 

From a CPT coding perspective there are some instances when you could report code 44005 with other intestine codes. In the instance where dense, extensive adhesions require significantly greater physician work and procedural complexity, it would be appropriate to report code 44005-59 in addition to the intestinal surgery procedure. The physician would need to document these circumstances in the operative report. 

Enterolysis

 CPT Assistant, April 2000 Page: 10 Category: Coding Consultation 

Related Information 
SurgeryDigestive System 

Question 

When extensive enterolysis of adhesions is performed during hernia repair, is it appropriate to report code 44005, Enterolysis (freeing of intestinal adhesion) (separate procedure), in addition to the hernia repair codes (49495-49659)? 

AMA Comment 

 Code 44005 is designated as a separate procedure and is considered an integral component of the hernia repair codes. Therefore, code 44005 should not be reported separately. However, if the physician feels that the enterolysis performed was extensive and added significantly to the overall procedure, then modifier -22, Unusual procedural service, may be appended to the appropriate hernia repair code. A report should be submitted with the claim to describe the unusual work performed.


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