CPT Code 58660 Laparoscopy, Surgical; with Lysis of Adhesions (Salpingolysis, Ovariolysis)

Accurate coding for laparoscopic surgical procedures is vital for OBGYN providers to ensure compliance and prevent denials. CPT 58660 represents a laparoscopic lysis of adhesions involving the oviducts and/or ovaries - a procedure commonly performed to treat pelvic pain, infertility, or postoperative scarring.

Since adhesiolysis can vary in complexity and purpose, precise documentation and correct code selection are essential for accurate reimbursement.

CPT Code 58660 – Description of the Procedure

Official CPT Definition: “Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis).”

This code covers laparoscopic surgical removal or destruction of adhesions (scar tissue) from around the fallopian tubes (salpingolysis) and/or ovaries (ovariolysis). Adhesions can form due to prior infections, endometriosis, pelvic surgery, or inflammation, and may cause infertility or chronic pelvic pain.

Key Aspects of CPT 58660:

• Approach: Laparoscopic (minimally invasive).
• Anatomic Focus: Ovaries and/or fallopian tubes.
• Purpose: To restore tubal or ovarian function or relieve pain.
• Complexity: May range from simple thin adhesions to dense fibrotic bands requiring advanced dissection.

When to Use CPT 58660

Report CPT 58660 when a physician performs laparoscopic surgical adhesiolysis specifically targeting adhesions that involve the ovaries or fallopian tubes.

Typical Indications Include:

• Chronic pelvic pain from adhesions.
• Infertility due to tubal or ovarian adhesions.
• Endometriosis-related pelvic adhesions.
• Pelvic scarring following prior infection or surgery (e.g., appendectomy, C-section).

Do not use CPT 58660 when:

• The adhesiolysis is incidental or part of a more extensive laparoscopic procedure (e.g., hysterectomy, salpingectomy). In that case, it’s bundled into the primary code.
• Adhesions are in other areas (e.g., bowel or peritoneal cavity only) - report 49329 (unlisted laparoscopic procedure) if appropriate.
• The procedure is open (non-laparoscopic) - use 58740 instead.

Coding Guidelines and Billing Rules

Understanding coding conventions helps ensure clean claims and proper payment.

• Single reporting: Report 58660 once per operative session, regardless of the number of adhesions treated.
• Bundling: If adhesiolysis is performed incidentally during another laparoscopic surgery, it’s not separately billable unless documentation supports it as a distinct, extensive therapeutic procedure.
• Global period: 90 days.
• Setting: Typically performed in a hospital or ambulatory surgical center (ASC).
• Prior authorization: Some payers require documentation of medical necessity (e.g., infertility workup or pelvic pain unresponsive to medical management).

Proper documentation of adhesions, extent, and surgical complexity is essential for justification and payer approval.

Reimbursement and Coverage Information

Medicare National Payment Averages (Approximate):

• Physician (Facility): $800–$950
• ASC Payment: $1,500–$1,800
• Hospital Outpatient: $2,200–$2,500
• Global Period: 90 days

Common ICD-10 Codes Supporting Medical Necessity:

• N73.6 – Female pelvic peritoneal adhesions.
• N97.1 – Female infertility of tubal origin.
• R10.2 – Pelvic and perineal pain.
• N80.9 – Endometriosis, unspecified.

Coverage and payment vary by payer and region; always confirm preauthorization requirements and payer policies before surgery.

Appropriate Modifier Use

Use modifiers to clarify service circumstances:

• Modifier 59 – Distinct procedural service (if adhesiolysis is unrelated to another procedure in the same session).
• Modifier 51 – Multiple procedures (if performed with another laparoscopic code).
• Modifier 52 – Reduced service (if procedure is incomplete or partial due to extensive adhesions or limited visualization).
• Modifiers 54/55 – For shared care (surgical vs. postoperative management).

Documentation must fully support modifier use, especially for unbundling scenarios.

Documentation Requirements

Detailed operative notes support proper reimbursement and compliance:

• Preoperative diagnosis and indication (pain, infertility, prior adhesions).
• Extent and location of adhesions (ovarian, tubal, or pelvic).
• Surgical findings: Type, density, and severity of adhesions.
• Technique used: Sharp or blunt dissection, cautery, laser, or hydrodissection.
• Time and complexity: Important when adhesiolysis is extensive.
• Confirmation of restored anatomy or mobility.
• Pathology or images (if applicable).

Comprehensive documentation strengthens medical necessity and prevents denials.

Example Scenarios

Scenario 1 – Laparoscopic Adhesiolysis for Pelvic Pain

A 35-year-old woman presents with chronic pelvic pain unresponsive to medication. Laparoscopy reveals dense adhesions surrounding both fallopian tubes, which are carefully dissected and freed.

→ Report CPT 58660.

Scenario 2 – Infertility Due to Tubal Adhesions

A patient with secondary infertility undergoes diagnostic laparoscopy, and the surgeon performs extensive adhesiolysis of both tubes and ovaries to restore patency.

→ Report CPT 58660.

Scenario 3 – Incidental Adhesiolysis During Hysterectomy

During a laparoscopic hysterectomy, minor adhesions between the ovary and pelvic sidewall are released to facilitate exposure.

→ Do not report CPT 58660 separately - this is incidental and bundled into the primary hysterectomy code.

These examples illustrate how documentation determines whether adhesiolysis qualifies as a billable, standalone service.

Why Choose BillingFreedom for OBGYN Billing

Laparoscopic procedures like CPT 58660 require precise documentation, careful modifier use, and accurate code selection to prevent denials. Even small errors in coding or incomplete operative notes can delay payments or trigger payer audits.

At BillingFreedom, our certified coders specialize in OBGYN medical billing services, helping practices:

• Identify billable versus bundled services accurately.
• Apply correct modifiers for complex laparoscopic cases.
• Manage prior authorization and payer documentation requirements.
• Ensure compliance with current CMS and AAPC coding updates.

With BillingFreedom, your claims stay compliant, your reimbursements improve, and your team can focus on patient care.

For more details about our exceptional 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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