Ob-Gyn Coding Alert

" Ob-gyn coders often include lysis of adhesions in the primary surgery, but you can get paid separately for the procedure if the adhesions are extensive.
 
Pelvic adhesions are bands of fibrous scar tissue that can form in the abdomen and pelvis after surgery or due to infection. Because adhesions connect organs and tissue that normally are separated, they can lead to a variety of complications, including pelvic pain, infertility and bowel obstruction. Adhesions commonly form on the ovaries, pelvic side walls and fallopian tubes.
 
Although ob-gyns generally deal with lysis of adhesions in only four sites, CPT provides six codes for the associated procedures:
 
   44005 - Enterolysis (freeing of intestinal adhesion) (separate procedure)
 44200 - Laparoscopy, surgical; enterolysis (freeing of intestinal adhesion)   (separate procedure)
 56441 - Lysis of labial adhesions
 58559 - Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)
 58660 - Laparoscopy, surgical; with lysis of adhesions (salpingolysis,    ovariolysis) (separate procedure)
   58740 - Lysis of adhesions (salpingolysis, ovariolysis).   Generally, you should separately report adhesiolysis in only two situations when performed with another procedure(s):
 1. when lysis of adhesions is extensive
 2. when the adhesions are in a different anatomic site from the main procedure(s). If the lysis of adhesions is extensive and bundled into the primary procedure by the National Correct Coding Initiative or some other bundling software, you should add modifier -22 (Unusual procedural services) to the primary procedure code. Otherwise, you should report extensive adhesiolysis separately.
 
You should use modifier -22 only rarely, says Jean Ryan-Niemackl, LPN, CPC, content analyst for QuadraMed health information management division in Fargo, N.D. Every surgeon has cases that are harder than average and ones that are easier" and just because a case is more extensive or time-consuming than another is not reason to use modifier -22."
 
To report modifier -22 you should have supporting documentation that details the physician's extensive time and work effort. "Modifier -22 will most certainly initiate a request for information from your carriers so it is important that you have good substantiation in the operative report " Ryan-Niemackl says.
 
The following tips will help you pin down when you should report lysis of adhesions separately.

Tip #1:
Separate Codeable Adhesiolysis From Noncodeable When determining whether you should code adhesiolysis in addition to the primary procedure you first have to examine the ob-gyn's documentation. Carriers usually don't reimburse separately for removing soft filmy adhesions by blunt dissection when the physician performs the lysis with other procedures. His or her documentation must [...]