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Oct 24th, 2017 - Streeter 1 

Surgery coding

Laparoscopy, lysis of adhesions, Abdominal laparotomy with drainage of abscess, cholecystectomy with much difficulty, pelvic laparotomy, excision of mass anterior to uterus and between bladder and uterus.
Left salpingo-oophorectomy with a large cyst removal. Placement of drain.
Gyne exam under anesthesia with pap smear.
Need help coding this: I am looking at 47600-22, 58140, 58925 and Q0091. Or should I try and code the lysis with a 59 modifier??
Thanks!

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Oct 26th, 2017 - ChrisW   39  1 

Watch for NCCI edits

There is an NCCI edit that exists with 58925 Ovarian cystectomy, unilateral or bilateral and 58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure).

Therefore; the two codes cannot be billed together. Determine the reason for the encounter; I am assuming the physician had planned the Cholecystectomy, which would need to be billed. I would bill for the Cholecystectomy, (The NCCI results were from FindACode.com, using the NCCI Validator. The edit is based on anatomic considerations with the following results.

NCCI Edit Results:
Edit exists with 58925. 58660 is a Column 2 code. If both 58925 and 58660 are submitted, only 58925 will be paid.
- This edit CANNOT be overridden via CCI-associated modifiers.
- Rationale: CPT "separate procedure" definition

The other codes look appropriate along with the 22 modifier for Increased Procedural Services as the physician notes the cholecystectomy was done with much difficulty.

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