You Be the Coder:
Bundling Riddle
Published on Fri Mar 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: How should I code for lysis of extensive pelvic and peri-adnexal adhesions to omentum, partial left oophorectomy and partial omentectomy? My inclination is to use 58940 for the oophorectomy, 49255 for the omentectomy, and 58740 for the lysis of adhesions, but I'm afraid of running into bundling problems.
Florida Subscriber
Answer: You are correct to be concerned about bundling. CPT considers 49255 (Omentectomy, epiploectomy, resection of omentum [separate procedure]) a separate procedure; 58740 (Lysis of adhesions [salpingolysis, ovariolysis]) is for lysis of adhesions, a procedure Medicare refuses to pay for unless exceptional additional work is documented.
If this is a Medicare patient and you want to get credit for extra work, add modifier -22 (Unusual procedural services) to 58940 (Oophorectomy, partial or total, unilateral or bilateral).
If this is a private payer, list the codes you have indicated unless you know for sure that the payer always denies the lysis of adhesions on the first try (it would be less likely to deny the omentectomy).
The omentectomy is more extensive and has more RVUs than the oophorectomy, so it would go first on the claim form.
Because 49255 is a separate procedure, you may have to add modifier -59 (Distinct procedural service) to the code.
The next code you list will be 58940-51 (Multiple procedures) and, if you decide that the adhesiolysis is adequately documented to show significant work, list 58740-51 last.
