Ob-Gyn Coding Alert

Question: How should I code a laparoscopic lysis of adhesions, a laparotomy with cystectomy on right side, a bilateral tubal ligation using filshie clips, and D&C? The patient's diagnosis was dermoid cyst with mild torsion, adhesions of the uterus and omentum, undesired fertility, and amenorrhea. Florida Subscriber Answer: First we have some conflicting information in this question that affects the answer.

You state that the lysis of adhesions was performed laparoscopically while the other procedures were done through a laparotomy (open) incision. Many payers don't allow you to code separately for each approach when a laparoscopic procedure is converted to an open procedure, and your ability to code depends very much on the documentation showing how much of the procedure was performed through the laparoscope before this conversion took place, and whether the payer recognizes lysis as a separately billable procedure in any case.

There are two coding solutions to this multistage surgery:

Option 1 assumes that the payer will allow you to bill the laparoscopic lysis of adhesions separately:

58925 (Ovarian cystectomy, unilateral or bilateral) for the dermoid cyst linked to 220 (Benign neoplasm of ovary)

58660-59-51 (Laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]; Distinct procedural service; multiple procedures) for the adhesions linked to 568.0 (Omental adhesions), 621.5 (Uterine adhesions) and V64.4 (Laparoscopic surgical procedure converted to open procedure)

58615-51 (Occlusion of fallopian tube[s] by device [e.g., band, clip, Falope ring] vaginal or suprapubic approach) linked with V25.2 (Admission for interruption of fallopian tubes or vas deferens)

58120-51 (Dilation and curettage, diagnostic and/or therapeutic [nonobstetrical]) with a linking diagnosis code of 626.0 (Absence of menstruation) because this appears to be the only diagnosis you have listed to justify the D&C. Option 2 assumes that the payer will not pay separately for a converted procedure, but that the documentation supports extensive lysis of adhesions:

58925-22
58615-51
58120-51. Answers to Reader Questions and You be the Coder provided by Melanie Witt, RN, CPC, MA, an ob/gyn coding expert based in Fredericksburg, Va.