Ob-Gyn Coding Alert

Question: The physician performed an exploratory laparotomy with lysis of adhesions, left ureterolysis, and left salpingo-oophorectomy and drainage of a right ovarian cyst. Should I report this as 50722 and 58720-51? California Subscriber Answer: No. You cannot report 50722 (Ureterolysis for ovarian vein syndrome) unless the ob-gyn performed the ureterolysis for ovarian vein syndrome (593.4). If the physician merely lysed adhesions around the ureter, CPT does not contain a code for this procedure. But if the adhesions were extensive, you could add a modifier -22 (Unusual procedural services) to the primary surgery to show the extra work involved. You also list other adhesions, so you can bill 58740 (Lysis of adhesions [salpingolysis, ovariolysis]) for the lysis if they were around the ovaries and tubes. In addition, you can report 58720 (Salpingo-oophorectomy, complete or partial, unilateral or bilateral [separate procedure]) for the salpingo-oophorectomy and 58800 (Drainage of ovarian cyst[s], unilateral or bilateral, [separate procedure]; vaginal approach) for draining the ovarian cyst. The codes should appear in this order: 58740 58720-59-51 (Distinct procedural service; multiple procedures) or 58720-LT-51 (Left side) 58800-59-51 or 58800-RT-51 (Right side). If the payer does not allow you to bill for the lysis of adhesions separately even when they are extensive, you will need to decide which procedure(s) took up the most time during the surgical session. That will mean that you will bill only for the lysis or only for the other two procedures. You have the option of adding modifier -22 to the primary code you decide to report to indicate the additional work.