Ob-Gyn Coding Alert

Question: Our doctor recently did a repeat c-section, and incidentally did a broad ligament repair and lysis of adhesions. How should we code for this?

Shirley A. Neal-Parker, MD
Chehalis, WA

Answer: There are a couple of different coding options for this circumstance. You can either code for the cesarean delivery using a modifier -22 (greater than usual services) added for the additional work done, or you could code for the cesarean and add the code for the lysis of adhesions using 587401 (lysis of adhesions) and appending modifier -51 (multiple procedures). There is no specific CPT code for repair of the broad ligament.

Remember that coding is not the same as coverage, however. Payers reimburse, in general, for the treatment of disease, illness, or symptoms. If the patient was having no complaints due to adhesions or if the repair of the broad ligament was necessitated due to iatrogenic causes, it is unlikely that the payer will reimburse for these incidental procedures. Also, keep in mind that lysis of adhesions is generally not reimbursed unless the documentation that accompany the claim clearly shows that the adhesions were dense, vascular, anatomy-distorting or something similar. It is not enough to simply use the code that indicates the presence of adhesions. Lysis of filmy adhesions by blunt dissectionno matter how manyis generally not reimbursed separately.