Wiki Laparosocpy and Drainage of Abscess

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JLM322

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I need help with finding a CPT code to fit the procedure performed by the doctor. The title of the operation was laparoscopy, lysis of adhesions, and drainage of abscesses with irrigation. I will submit the operative report with the claim but I still need to know what CPT code to use. There is "taking down" and "freeing up" adhesions surrounding the ovaries and tubes. The doctor dictates, "...there was a little bit of drainage of purulent matter out of the left tube. Irrigation was used in copiuos amounts, Cultures were taken...there was some pus in the right ovary. This was drained and irrigated. IV Levaquin and IV Flagyl were given at that point."

Here are my questions and concerns:

1) In the past when I submitted a similar operative report to an insuarnce company, the code was changed from a 58660 to 49320 because they deemed that the doctor did not really perform a "lysis of adhesions." He was only cutting down adhesions in order to explore the organs. Does anyone have a concrete definition of lysis of adhesions and what does a doctor need to document to prove that this procedure was done?

2) Should I use an unlisted CPT code? Should I use 49322 since the "drainage" is similar to an aspiration?

All comments appreciated!

Joanna
 
according to my coding companion, lysis definition is destruction, breakdown, dissoultion, or decomposition of cells or substances by a specific catalyzing agent.
what is your diagnosis?
 
Diagnosis is pelvic adhesions. My coding companion states that definition as well. I was wondering what terminology coders look for in an operative report that confirm lysis of adhesions was done.
 
generally you won't report lysis of adhesions separately if the physician does lysis to access the surgical site.
From the info you have provided sounds like you should code for the laparoscopic drainage of the abscesses, not the lysis of adhesions
 
i have an obgyn coding alert that states removing soft, filmy adesions by blunt dissection when performed with other procedures is not reimburseable. The documentation must describe work associated with the removal of adhesions such as using sharp dissection/sometimes laser of adhesions that are dense, very adherent and have a blood supply.
 
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