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You would only code the laparotomy. Now depending on the amount of time spent on the laparoscopy, and how much of the procedure was done laparoscopically, you could code it with the 53 modifer and lower the amount billed, and code the laparotomy. The documentation MUST support that a significant portion was done laparoscopically. If they go in their with the laparoscope, can't do anything and open her up, just do the laparotomy.
 
You would just bill out the laparotomy with the dx V64.41 showing that it was a laparoscopic procedure converted to open along with the adhesion dx. Of course the V code would be after the adhesion dx code. If the provider spent an extensive amount of time on the laparoscopic portion, you could attach modifier 22 to the laparotomy code and increase your fee for the procedure and send the operative report along with the claim. Hope this helps!
 
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