Ob-Gyn Coding Alert

Question: How should I code a laparoscopic lysis of adhesions, a laparotomy with cystectomy on the right side, and 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.

Pennsylvania Subscriber

 
Answer: There is some conflicting information in this question that will affect 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 will not allow you to code separately for each approach when a laparoscopic procedure is converted to an open one. The coding will depend 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. There are two coding options to this multistage surgery:
 
Option 1 assumes that the payer will allow you to bill the laparoscopic lysis of adhesions separately linked to the following ICD-9 codes:
 

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 (omentum 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; multiple procedures) linking this with V25.2 (admission for interruption of fallopian tubes or vas deferens);
 

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

58925-22 (... -unusual procedural services)
 

58615-51
 

58120-51.