natashalage
Expert
Hello Coding Community 
Could you please tell me if I can add modifier -22 for dense lysis of adhesions to 58662? I think I could use -22 based on MD's statement that Adhesions were ' dense', 'very dense'; however, MD didn't put the extra time spent on it and that's why i am not sure if -22 is warranted? Thank you very much for your rational. CPT: 58571 58662 -22 51
DX: pelvic adhesive disease, chronic pelvic pain+ endometriosis 58662 +confirmed fistula
Px: Procedure: Laparoscopy, total hysterectomy, bilateral salpingectomy 58571, excision of endometriosis, lysis of adhesions 58662, left ureterolysis
Laparoscopy: Adhesions of omentum to the anterior abdominal wall at the level of the umbilicus. Normal appearing uterus, right ovary, and fallopian tube. Dense adhesions of the left fallopian tube and ovary to the left pelvic sidewall. Very dense adhesions of the bladder to the lower uterine segment with densest area a the dome of the right bladder with a thin film of underlying uterine tissue consistent with area of likely fistula. ~ 2 cm cystotomy made during dissection of this dense area that repaired in two layers with a water tight seal. Superficial blue black lesions of endometriosis noted on the upper lateral pelvic side walls bilaterally
Just part of op note; Adhesions of omentum to anterior abdominal wall near the umbilicus were taken down with the harmonic scalpel. The superficial lesions of endometriosis on the bilateral upper pelvic side walls were excised with a border of peritoneum using using the harmonic.
Attention was first turned to the hysterectomy. The left rectal reflection was taken down from the left pelvic side wall at the level of the pelvic brim. The left ureter was identified. A left ureterolysis was performed from the level of the pelvic brim to it insertion below the uterine artery. The IP ligament was identified. The perirectal and perivesicular spaces were further developed. Now that the ureter was identified and lateralized, the adhesions of the left fallopian tube and ovary to the pelvic side wall were taken down with the harmonic. The round ligament was put on traction, transected with the Harmonic scalpel, and the anterior and posterior leaf of the broad ligament separated. The incision was then extended anteriorly toward the lower uterine segment to create the bladder flap. The bladder was further dissected off of the lower uterine segment. A peritoneal window was made in the broad ligament between the uterus, uteroovarian ligament and the ureter lateralizing the ureter and isolating the uteroovarian ligament. The fallopian tube was transected from the fimbriated end to the insertion at the cornua and removed later attached to the uterine specimen. The ureter was identified lateral to the created periotoneal window and the uteroovarian ligament was desicated with the bipolar and transected with the Harmonic scalpel. The posterior leaf of the broad ligament was transected off lower uterine segment/cervix. The uterine vessels were skeletonized, desicated with the bipolar, and transected with the Harmonic scalpel. Attention was then turned to the right side, where in a similar fashion, the round ligament, uteroovarian ligament, and uterine vessels were desicated and transected. The remaining bladder adhesions were dissected from the lower uterine segment. Of note a very dense area of adhesions was noted along the right lower uterine segment with a thin region of residual serosa surrounding the uterus at this point consistent with the area of questionable fistula on imaging. These remaining adhesions were taken down with cold scissors. An ~ 2 cm cystotomy was noted after adhesiolysis. It was sutured close with a single interrupted suture of 2-0 vicryl as a tag for later repair. The uterine manipulator cup was idenitfied, elevated superiorly, and the Harmonic scalpel was used to perform the colpotomy. The uterus was removed through the colpotomy. The colpotomy was closed laparoscopically with 0 V-lock in a continuous fashion with several back bites taken to ensure integrity.
Could you please tell me if I can add modifier -22 for dense lysis of adhesions to 58662? I think I could use -22 based on MD's statement that Adhesions were ' dense', 'very dense'; however, MD didn't put the extra time spent on it and that's why i am not sure if -22 is warranted? Thank you very much for your rational. CPT: 58571 58662 -22 51DX: pelvic adhesive disease, chronic pelvic pain+ endometriosis 58662 +confirmed fistula
Px: Procedure: Laparoscopy, total hysterectomy, bilateral salpingectomy 58571, excision of endometriosis, lysis of adhesions 58662, left ureterolysis
Laparoscopy: Adhesions of omentum to the anterior abdominal wall at the level of the umbilicus. Normal appearing uterus, right ovary, and fallopian tube. Dense adhesions of the left fallopian tube and ovary to the left pelvic sidewall. Very dense adhesions of the bladder to the lower uterine segment with densest area a the dome of the right bladder with a thin film of underlying uterine tissue consistent with area of likely fistula. ~ 2 cm cystotomy made during dissection of this dense area that repaired in two layers with a water tight seal. Superficial blue black lesions of endometriosis noted on the upper lateral pelvic side walls bilaterally
Just part of op note; Adhesions of omentum to anterior abdominal wall near the umbilicus were taken down with the harmonic scalpel. The superficial lesions of endometriosis on the bilateral upper pelvic side walls were excised with a border of peritoneum using using the harmonic.
Attention was first turned to the hysterectomy. The left rectal reflection was taken down from the left pelvic side wall at the level of the pelvic brim. The left ureter was identified. A left ureterolysis was performed from the level of the pelvic brim to it insertion below the uterine artery. The IP ligament was identified. The perirectal and perivesicular spaces were further developed. Now that the ureter was identified and lateralized, the adhesions of the left fallopian tube and ovary to the pelvic side wall were taken down with the harmonic. The round ligament was put on traction, transected with the Harmonic scalpel, and the anterior and posterior leaf of the broad ligament separated. The incision was then extended anteriorly toward the lower uterine segment to create the bladder flap. The bladder was further dissected off of the lower uterine segment. A peritoneal window was made in the broad ligament between the uterus, uteroovarian ligament and the ureter lateralizing the ureter and isolating the uteroovarian ligament. The fallopian tube was transected from the fimbriated end to the insertion at the cornua and removed later attached to the uterine specimen. The ureter was identified lateral to the created periotoneal window and the uteroovarian ligament was desicated with the bipolar and transected with the Harmonic scalpel. The posterior leaf of the broad ligament was transected off lower uterine segment/cervix. The uterine vessels were skeletonized, desicated with the bipolar, and transected with the Harmonic scalpel. Attention was then turned to the right side, where in a similar fashion, the round ligament, uteroovarian ligament, and uterine vessels were desicated and transected. The remaining bladder adhesions were dissected from the lower uterine segment. Of note a very dense area of adhesions was noted along the right lower uterine segment with a thin region of residual serosa surrounding the uterus at this point consistent with the area of questionable fistula on imaging. These remaining adhesions were taken down with cold scissors. An ~ 2 cm cystotomy was noted after adhesiolysis. It was sutured close with a single interrupted suture of 2-0 vicryl as a tag for later repair. The uterine manipulator cup was idenitfied, elevated superiorly, and the Harmonic scalpel was used to perform the colpotomy. The uterus was removed through the colpotomy. The colpotomy was closed laparoscopically with 0 V-lock in a continuous fashion with several back bites taken to ensure integrity.
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