OBGYN Coding - Bust 5 Adhesiolysis Coding Myths: When You Can Report It Separately

Think lysis of adhesions is always bundled? Not so fast.

In OBGYN coding, few services cause as much confusion and inconsistency as lysis of adhesions. Coders often encounter mixed messages from payers, unclear CPT bundling guidelines, and operative notes that don’t clearly indicate whether adhesiolysis should be billed separately or if it can be billed at all.

The situation gets even more complex when you factor in NCCI edits and the proper application of modifier 22 for increased procedural services, both of which can impact claim outcomes.

This article clarifies the uncertainty by dispelling common myths, outlining documentation essentials, and explaining precisely when it’s appropriate and compliant to report lysis of adhesions. From pelvic to intestinal to omental cases, this guide gives you the clarity you need to code accurately and confidently.

Myth 1: Code 58740 Is Always Bundled

Scenario: During abdominal surgery, an OBGYN encounters thick pelvic adhesions that distort normal anatomy and take significant time to remove. Can this be billed?

Answer: The ability to report depends on the type of adhesions and the payer’s bundling policy.

Pelvic adhesions often develop after infection or surgery and may connect organs such as the fallopian tubes, ovaries, or pelvic sidewalls.

Code 44005, which describes enterolysis or the freeing of intestinal adhesions, is typically bundled into abdominal procedures. Code 58740, which refers to lysis of adhesions such as salpingolysis or ovariolysis, is bundled with only certain procedures.

Key Point: When adhesions involve the ovaries or tubes and the operative report documents the additional work, code 58740 may be appropriate. Modifier 22 should not be used in this situation because the service is reported as a separate procedure rather than an extra effort on the primary one.

Documentation should clearly include

• Evidence that the adhesions were dense, vascular, and required sharp dissection or laser
• Details on the additional time the adhesiolysis added to the case
• An explanation of why the adhesiolysis was required, beyond providing access for the main surgery

Myth 2: Modifier 22 Cannot Be Used With Bundled Codes

Scenario: An OBGYN performs a laparotomy for a hysterectomy. The surgeon spends two hours lysing thick bowel and omental adhesions just to reach the uterus. Can this be billed separately?

Answer: No. Code 44005 cannot be reported with 58150, which describes a total abdominal hysterectomy, because the National Correct Coding Initiative (NCCI) rules bundle 44005 into 58150.

NCCI assigns this pair a “0” modifier indicator, which means no modifier, including 59 for a distinct procedural service or 22, can override the edit to unbundle the services.

Key Point: In this situation, the correct approach is to append modifier 22 to the primary code, reporting 58150 with modifier 22. The operative note must specifically describe the extensive adhesiolysis, the additional time it required, and the impact on the overall difficulty of the procedure.

Myth 3: There Is Only One Way to Report Lysis of Adhesions

Scenario: During a repeat cesarean section, the surgeon lyses omental adhesions and uses cautery to create adequate exposure for the procedure. Can this be billed separately?

Answer: It depends. If the operative note shows adhesions on the fallopian tubes or ovaries, code 58740 may be an option. However, many payers include 58740 in their coverage for cesarean delivery services.

Key Point: When the payer bundles 58740 into a cesarean, the correct alternative is to append modifier 22 to the cesarean delivery code. This is only appropriate if the documentation clearly demonstrates that the adhesiolysis was extensive and significantly increased the difficulty of the case.

Myth 4: The Term “Separate Procedure” Means It Can Never Be Reported

Scenario: A detailed laparoscopic operative note describes extensive omental, pelvic, and bowel adhesions that required significant time and effort to remove. Can the adhesiolysis be billed?

Answer: Yes, but only under certain circumstances. There are two laparoscopic codes available for adhesiolysis:

• 44180 for laparoscopic enterolysis, which involves freeing intestinal adhesions
• 58660 for laparoscopic lysis of adhesions involving the fallopian tubes or ovaries

Key Point: Both codes are designated as “separate procedures.” This means they will be bundled when performed along with other laparoscopic operations, such as an appendectomy. However, when adhesiolysis is the only service reported, the correct code should reflect the primary focus of the work performed. In the described scenario, 58660 may be the better choice based on the operative details.

Myth 5: Lysis of Adhesions Cannot Be Reported When Surgery Converts From Laparoscopic to Open

Scenario: A surgeon begins a laparoscopic uterosacral suspension, but the presence of extensive adhesions makes the procedure impossible to complete laparoscopically. The case is then converted to an open operation. Can the laparoscopic portion be billed separately?

Answer: No. Medicare and most commercial insurers treat the laparoscopic attempt as bundled into the open procedure. Separate reporting of the laparoscopic work is not allowed.

Correct Coding: Report the open procedure, such as 57283 for colpopexy by intraperitoneal approach, with modifier 22 if the documentation demonstrates that adhesions significantly increased operative time and effort.

Documentation should clearly show

• The reason the laparoscopic approach had to be abandoned
• The amount of time spent attempting the laparoscopic portion
• The specific operative difficulties, such as dense adhesions or altered anatomy

Tip: A cover letter comparing this case to standard operative times and complexity can strengthen the claim.

Your Essential CPT® Codes for Adhesiolysis

The correct code depends on the anatomic site and the surgical approach. Common options include:

• 44005: Enterolysis, freeing of intestinal adhesions, separate procedure
• 44180: Laparoscopy, surgical, enterolysis (freeing of intestinal adhesions), separate procedure
• 50715: Ureterolysis with or without repositioning of the ureter for retroperitoneal fibrosis
• 50722: Ureterolysis for ovarian vein syndrome
• 53500: Urethrolysis, transvaginal, secondary, open, including cystourethroscopy for postsurgical obstruction or scarring
• 53899: Unlisted procedure, urinary system
• 56441: Lysis of labial adhesions
• 58559: Hysteroscopy, surgical, with lysis of intrauterine adhesions by any method
• 58660: Laparoscopy, surgical, with lysis of adhesions involving the fallopian tubes or ovaries
• 58740: Lysis of adhesions, salpingolysis or ovariolysis

Reminder: Many adhesiolysis codes are bundled when performed in conjunction with other procedures. Always review current NCCI edits and payer-specific guidelines before reporting.

Maximize Reimbursement with BillingFreedom Expert Adhesiolysis Coding Support

Coding for lysis of adhesions is one of the most complex areas in obstetrics and gynecology (ob-gyn) and surgical medical billing. From understanding when 58740 can stand alone, to applying modifier 22 correctly, to navigating NCCI edits and payer-specific bundling rules, minor errors can lead to denials and lost revenue. With numerous myths, exceptions, and documentation requirements, practices often struggle to code accurately and in compliance with regulations.

BillingFreedom specializes in resolving these challenges. Our team stays ahead of coding changes, payer policies, and compliance rules to ensure every case is billed with maximum accuracy and efficiency. Whether it’s pelvic, intestinal, or omental adhesiolysis, we know exactly how to capture legitimate reimbursement while protecting providers from costly errors. Partner with us to transform complex OBGYN medical billing scenarios into smooth, revenue-positive outcomes.

For more details about our exceptional OB/GYN medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472. 

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