Resolved 58660 listed under Adhesions Liver

[ErnaV_2250]

Dear CCO, please can I ask for clarification. In the E-Book Index Adhesions > Liver > Lysis > 58660.



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

The Desk Reference: focusing on female genial procedure only ?
First, the provider places the patient in the dorsal lithotomy position, then preps and drapes the abdomen, and administers a general anesthetic. The provider places a uterine manipulator through the cervix so he can move the uterus around during the surgery. The provider enters the abdominal cavity near the belly button using a Veress needle or an open incision and places a laparoscope. The provider insufflates the abdomen with CO2 gas to create a pneumoperitoneum and then puts the patient into the Trendelenburg position. He then makes small incisions around the abdominal area to insert trocars to better view the operating site and insert surgical tools.
If the provider is performing robotic surgery, he docks the robot to the laparoscope at this time. The provider then inspects the abdominal cavity and identifies the location, shape, and extent of adhesions around the tubes or ovaries. The provider breaks down the scar tissue, or adhesions, of the fallopian tubes or ovaries using scissors, laser, cauterizing instruments with high-frequency electric current, or other techniques until he removes all the adhesions. He then performs chromotubation, if necessary, to check the openness of the fallopian tubes. He then irrigates and deflates the abdominal cavity and removes all instruments and trocars. He closes the trocar site fascia and skin and removes all instruments from the vagina.

Should code 58660 be used for Adhesions to be removed laparoscopically if at the Liver? Should this not be a 44180? or laparoscopic procedure unspecified?
What if the patient is male? Then 58660 do not make sense.
[I understand the fact that it is normally bundled/ or when used with modifier -22. This is however a patient that went for this only [history previous lobectomy - formed adhesions and it caused severe abdominal pain. Went to theatre for adhesiolysis only]

Is this perhaps an Index error?


Regards
Erna

 

[Alicia]

I see how this can be confusing.
There is no code for adhesions for the liver. Look up Lysis
Here is what the CPT Assistant states:
February 2018 page 11
Surgery: Digestive System

Question: What Current Procedural Terminology (CPT®) code(s) should be reported when an operative intervention is performed solely for lysis of intestinal adhesions?

Answer: If lysis of intestinal adhesions is performed independent of any other procedure, code 44005, Enterolysis (freeing of intestinal adhesion) (separate procedure), or code 44180, Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure) may be reported, as appropriate.

 

[Laureen]

This is an example of where the CPT Index could have done a better job.

When I start with lysis then adhesions in the index I get these choices - which to me makes 44180 the better choice. And as you noted 58660 is in the female genital system coding range. 44180 is in the digestive system of which the liver belongs.