Ob-Gyn Coding Alert

Question: My ob-gyn performed an "operative laparoscopy adhesiolysis, abdominal myomectomy." How should I report this?

Answer: In other words, your ob-gyn performed laparoscopic lysis of adhesions, then converted to an open myomectomy.

For the laparoscopic lysis of adhesions, you should report 58660 (Laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]). To report this code, you should make sure that the type of adhesions your ob-gyn addressed is the kind that payers normally reimburse. If your ob-gyn does not thoroughly describe the adhesions in the op report, trying to report the lysis is a waste of your time and a line item on the claim form.

For the abdominal myomectomy, you should report either 58140 (Myomectomy, excision of fibroid tumor[s] of uterus, 1 to 4 intramural myoma[s] with total weight of 250 grams or less and/or removal of surface myomas; abdominal approach) or 58146 (Myomectomy, excision of fibroid tumor[s] of uterus, 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams, abdominal approach).

When listing the codes on your claim, list 58140 or 58146 first, followed by the lysis code (58660). You don't need a "separate procedure" modifier, because you won't find this code combination bundled in the National Correct Coding Initiative.

Heads up: Be sure to include V64.41 (Laparoscopic surgical procedure converted to open procedure) as a diagnosis for the open procedure in addition to the diagnosis for the surgery itself.

Keep in mind: If the ob-gyn intended to do a laparoscopic myomectomy and found adhesions but did not remove them laparoscopically, then converted to perform the abdominal myomectomy, you should bill the myomectomy code with modifier 22 (Increased procedural services) only. Payers will bundle the lysis in this circumstance.