Ob-Gyn Coding Alert

Although ob-gyns generally deal with lysis of adhesions in only four sites, CPT provides ten codes for the associated procedures:

- 44005 -- Enterolysis (freeing of intestinal adhesion) (separate procedure)

- 44180 -- Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)- 50715 -- Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis

- 50722 -- Ureterolysis for ovarian vein syndrome

- 53500 -- Urethrolysis, transvaginal, secondary,open, including cystourethroscopy (e.g., postsurgical obstruction, scarring)- 53899 -- Unlisted procedure, urinary system (for adhesions involving urethra, retropubic approach)

- 56441 -- Lysis of labial adhesions

- 58559 -- Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)- 58660 -- Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)- 58740 -- Lysis of adhesions (salpingolysis, ovariolysis).

Important: Generally, you won't use these codes if the ob-gyn does anything else, says Rachel Hollis, CPC, billing manager for Galisteo OB GYN Associates in Sante Fe, N.M. Rationale: -They are included in the primary procedure,- she says.

Look to Mod 22 For Extensive, Nonincluded Lysis

If the lysis of adhesions is extensive and the Correct Coding Initiative (CCI) or other bundling software includes this extensive service in the primary procedure,you should add modifier 22 (Increased procedural services) to the primary procedure code. Otherwise, you should report extensive adhesiolysis separately.

You should use modifier 22 only rarely, Hollis says.Caution: Every surgeon has cases that are harder than average and ones that are easier, and just because a case is more extensive or time-consuming than another is not sufficient reason to use modifier 22.

To report modifier 22, you should have supporting documentation that details the physician's extensive time and work effort, Hollis says. Modifier 22 will most certainly initiate a request for information from your carriers, so make sure the operative report substantiates the claim.