Pelvic Pain and Adhesions

The Coding Challenge

Question: A female patient with chronic complaints of left pelvic pain is taken to the operating room for a laparoscopy. Upon inspection of the pelvis, multiple adhesions were found attached to the right fallopian tube and ovary. A probe was used to bluntly lyse the adhesions. No other abnormalities were found. What is the procedure code for this service?

A. 58660
B. 58740
C. 58661
D. 49322

Answer:

B. 58660

The patient has left pelvic pain, which is chronic, and is seen for a laparoscopy. During the laparoscopy, multiple adhesions (bands of scar tissue) were found on the fallopian tube and ovary. The surgeon cuts away the adhesions.

Chronic Pelvic Pain

According to the Mayo Clinic, there are many possible causes of chronic pelvic pain (CPP). Diagnosing it can involve a process of elimination. Laparoscopy is one of the procedures that might be performed to diagnose CPP and may help in the diagnosis of endometriosis or chronic pelvic inflammatory disease. Laparoscopic surgery can also be used to correct an underlying cause of chronic pelvic pain.

Related Medical Terms

When a surgical laparoscopy with lysis of adhesions of the fallopian tubes is performed, it is referred to as a salpingolysis. When the same procedure is performed on the ovaries, it is referred to as an ovariolysis. 

Salping/o means fallopian tube.

Ovari/o means ovary.

Lysis means destruction and is often used in relation to scar tissue or adhesions. 

Lysis can be used alone or as a suffix, such as in adhesiolysis, which means the destruction of adhesions.

Surgical Laparoscopic Lysis of Adhesions Procedure

A surgeon performs the procedure by inserting forceps into the vagina and grasps the cervix. The uterus is then bent forward. A port is placed around the navel area, and space is created in the peritoneal cavity with air insufflation to improve visualization. A laparoscope (thin flexible scope with a camera) is inserted, and the abdominal cavity is inspected. 

The scar tissue surrounding the fallopian tubes and ovaries is carefully divided. This is accomplished by use of blunt or sharp dissection, laser, or electrocautery. Once all adhesions have been cut and mobility and function is restored in the fallopian tubes and ovaries, a temporary protective material is placed in the pelvic cavity. This keeps new adhesions from forming. Instruments are then withdrawn and portal incisions are closed. 

CPT Coding

In the CPT codebook, Laparoscopic Procedures on the Oviduct/Ovary (58660-58679) are located in the Female Genital System subsection of the Surgery section.

Locate and Verify

Looking in the Alphabetic Index under Laparoscopy, ovary/oviducts, it refers us to 49322, 58660-58679. 

In the Tabular, we can verify our correct code as:

58660, Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)

There are other ways you can find the right code in the Alphabetic Index; i.e. under Pelvic, lysis, or under Lysis, adhesions, ovary.

According to the CPT coding guidelines, a surgical laparoscopy always starts out as a diagnostic laparoscopy. Therefore, the diagnostic laparoscopy is not reported separately. Instead, it is included in the code for the surgical laparoscopy. 

CPT 58660 To Report Extra Time and Effort

In the scenario provided, the surgical laparoscopic lysis of adhesions was performed alone. However, sometimes, a surgical laparoscopy with lysis of adhesions is performed in combination with another primary surgical laparoscopic procedure. When this occurs, CPT code 58660 should not be reported separately unless extra time and effort is required to carry out the procedure. The reason for this is that generally lysis of adhesions is included in the primary laparoscopic surgery. 

When extra time and effort is needed for the lysis of adhesions, code 58660 may be reported separately as long as the documentation explains the difficulty involved and the extra amount of time necessary for the procedure.

According to Buck’s Step-by-Step Medical Coding, another option is to use Modifier -22 and append it to the CPT code (58660-22) to indicate the procedure required more time than normal. Again, the documentation must indicate the time needed to complete the lysis portion of the procedure.

Incorrect Answers

B, C, and D are incorrect. 

B. 58740, Lysis of adhesions (salpingolysis, ovariolysis). This does not include a laparoscopic approach.

C. 58661, Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy

D. 49322, Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple) 

** This post was reviewed and updated on December 28, 2021. **

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