Bust 5 Adhesiolysis Coding Myths: When You Can Report It Separately
Think lysis of adhesions is always bundled? Think again. Lysis of adhesions is one of the most frequently misunderstood and inconsistently reported services in ob-gyn coding. Coders often face conflicting payer policies, confusing CPT® bundling rules, and vague operative reports that leave them unsure whether adhesiolysis can be billed separately — or at all. Adding to the challenge, National Correct Coding Initiative (NCCI) edits and the correct use of modifier 22 (Increased procedural services) can complicate claim submissions. This article clears the confusion by breaking down common myths, outlining documentation requirements, and showing exactly when — and how — you can report lysis of adhesions in compliance with coding guidelines. Whether you’re dealing with pelvic, intestinal, or omental adhesions, this guide will help you code with confidence and accuracy. Myth 1: Code 58740 Is Always Bundled Scenario: An ob-gyn performs abdominal surgery and lyses dense, anatomy-distorting pelvic adhesions that require significant time. Can you bill for this? Solution: It depends on the type of adhesions and payer-specific bundling policies. Pelvic adhesions can form after surgery or infection and may bind organs like the ovaries, fallopian tubes, or pelvic walls. Code 44005 (Enterolysis (freeing of intestinal adhesion) (separate procedure)) is commonly bundled into abdominal procedures. Code 58740 (Lysis of adhesions (salpingolysis, ovariolysis)) is only bundled into some procedures. Key: If the adhesions involve ovaries or tubes, and your physician’s documentation supports significant effort, you may be able to report 58740. Do not append modifier 22 to 58740 because you’re reporting it as a distinct procedure, not added work. Documentation must include: Myth 2: Modifier 22 Can’t Be Used With Bundled Codes Scenario: During a laparotomy for hysterectomy, the ob-gyn lyses dense bowel and omental adhesions, taking two hours just to expose the uterus. Can you report this separately? Solution: No — you can’t report 44005 with 58150 (Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s)), because of National Correct Coding Initiative (NCCI) bundling rules. NCCI bundles 44005 into 58150 with a “0” modifier indicator, which means no modifier (including 59 [Distinct procedural service] or 22) will bypass the edit. In this case, you should report the extra adhesiolysis effort by appending modifier 22 to the primary procedure (58150-22), and ensure the documentation clearly explains the extent and duration of the adhesiolysis. Myth 3: There’s Only 1 Way to Report Lysis of Adhesions Scenario: During a repeat C-section, the ob-gyn lyses omental adhesions and uses cautery to expose the surgical field. Solution: Maybe. If adhesions are documented on the tubes or ovaries, you might report 58740. However, many payers bundle 58740 into cesarean deliveries. If that’s the case, consider appending modifier 22 to the C-section code — but only if the documentation supports extensive adhesiolysis work. Myth 4: ‘Separate Procedure’ Means You Can’t Ever Report It Scenario: A detailed laparoscopic op note describes widespread omental, pelvic, and bowel adhesions, which required significant effort and time to remove. Can you report the lysis? Solution: Yes — with conditions. You’re limited to two laparoscopic adhesiolysis codes: Important: Both are marked “separate procedures” and will be bundled if reported with other laparoscopic procedures (e.g., appendectomy). If only reporting adhesiolysis, choose the code representing the majority of surgical work. In this scenario, 58660 may be more appropriate based on the described work. Myth 5: You Can’t Code Lysis if Surgery Converts From Scope to Open Scenario: A laparoscopic uterosacral suspension is attempted, but massive adhesions force conversion to open surgery. Can you code the laparoscopy separately? Solution: No. Medicare and most commercial payers bundle the laparoscopic approach into the open procedure. You cannot bill separately for the scope work. Correct coding: Report the open procedure (e.g., 57283 [Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy)]) with modifier 22 if documentation shows significant extra time and effort due to adhesions. Make sure to look into your physician’s documentation for: Also: Include a cover letter comparing this case to typical operative times and complexity. Your Go-To CPT® Codes for Adhesiolysis Depending on location and approach, CPT® offers these codes: Reminder: Most adhesiolysis codes are bundled when other procedures are performed. Always check NCCI edits and payer policies. Suzanne Burmeister, BA, MPhil, Medical Writer and Editor
