B. 58660

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

Looking in the Alphabetic Index under Laparoscopy, ovary/oviducts, it refers us to 49322, 58660-58679. Verified in the Tabular, 58660 refers to 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 guidelines at CPT 58660, a surgical laparoscopy always includes diagnostic laparoscopy. To report a diagnostic laparoscopy
(peritoneoscopy) (separate procedure), use 49320.

In the scenario provided, the surgical laparoscopic lysis of adhesions was performed alone. However, according to AAPC, there are times when this procedure is performed in conjunction with another primary surgical laparoscopic procedure. When this occurs, CPT code 58660 is not to be reported separately unless the amount of time and effort warrants it because typically 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 for the procedure.

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 (according to AAPC’s Official CPC Study Guide 2018, pg. 210).

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)

Additional Information

Description of Procedure (CPT 58660)

A surgical laparoscopy with lysis of adhesions of the fallopian tubes (salpingolysis) or ovaries (ovariolysis) is performed in the following manner (according to Find-A-Code):

A surgical instrument called a tenaculum is used to insert into the vagina, grasp the cervix, and anteflex (bend forward) the uterus. A periumbilical port (adjacent to the navel) is placed and a pneumoperitoneum (the presence of air within peritoneal cavity) is brought about by blowing air into it. A laparoscope is then inserted and the abdominal cavity is inspected. Scar tissue surrounding the fallopian tubes and ovaries is carefully divided.

This procedure can be performed by blunt or sharp dissection, laser, or electrocautery and continues until the adhesions have all been severed and the tubes and ovaries have restored mobility and function. A temporary synthetic protective material is placed in the pelvic cavity to keep new adhesions from forming.

The pelvic area is inspected for bleeding, the instruments are removed, and pressure is placed on the abdomen to expel any remaining air in the peritoneum. The portal incisions are closed.

What Is Chronic Pelvic Pain (CPP)?

Chronic pelvic pain (CPP), lasting six months or longer, can be a condition of its own, or it can be caused by another medical condition. The pain occurs below the belly button and between the hips, according to the Mayo Clinic. Some causes of CPP include endometriosis, musculoskeletal problems, chronic pelvic inflammatory disease, ovarian remnant, fibroids, irritable bowel syndrome, painful bladder syndrome (interstitial cystitis), pelvic congestion syndrome, and psychological factors.

Because there are many possible causes of chronic pelvic pain, 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.

Here is an excellent video showing a surgeon performing a laparoscopic lysis of adhesions. At approximately 2:00, the actual procedure begins.