Adhesions involving the fallopian tubes or the ovary can lead to infertility, chronic pelvic pain and from previous surgery or infection or endometriosis.

CPT 58740 is applied to the open surgical lysis of adhesions (salpingolysis and/or ovariolysis) through an abdominal incision. Correct coding and documentation are crucial to OBGYN practices to capture the complexity of the procedure, maximize reimbursement and make sure practices are compliant with any payers' needs.

Description of CPT Code 58740

The official definition of CPT code 58740 is:

“Open surgical lysis of adhesions involving fallopian tube(s) (salpingolysis) and/or ovary(ies) (ovariolysis).”

Key points:

Performed through an abdominal incision (open approach).
Targets adhesions that interfere with fallopian tubes and/or ovaries.
Restores normal pelvic anatomy and organ function.
Preservation of reproductive organs is prioritized whenever possible.
Not for laparoscopic adhesiolysis (use 58660) or minor incidental adhesiolysis during other major procedures unless significant additional work is documented.

Scenarios Where CPT Code 58740 Is Applicable

You would bill CPT code 58740 in the following situations:

Infertility Due to Tubal or Ovarian Adhesions:

When a patient has scarring obstructing the fallopian tubes or ovaries and an open surgical approach is required to restore normal anatomy.

Chronic Pelvic Pain or Post-Surgical Complications:

For patients with chronic pelvic pain as a result of prior surgeries, infections or endometriosis, adhesiolysis may be necessary.

Examples:

A 32-year-old patient with a history of pelvic infection undergoes open abdominal lysis of dense adhesions surrounding both fallopian tubes to improve fertility.
A patient with prior endometriosis surgery presents with recurrent pain and infertility; adhesions are surgically lysed via laparotomy.

Applicable Modifiers for CPT Code 58740

Modifier 22 – Increased Procedural Services

If the adhesiolysis is extremely difficult because of dense or extensive adhesions, abnormal anatomy, or prior surgery, use.

Modifier 59 – Distinct Procedural Service

Applicable if adhesiolysis is performed separately from other major pelvic procedures and documented as clinically distinct.

CPT Code 58740 – Billing & Reimbursement

Here are the important steps to take when submitting CPT code 58740 for proper reimbursement:

Justify Medical Necessity:

Record the presence, location and severity of adhesions (which is used to decide whether open surgery or laparoscopy is required), and the benefit that is likely to occur (e.g. return of fertility, pain relief).

Use Accurate ICD-10 Codes:

Use Accurate ICD-10 Codes:

N73.6 – Pelvic adhesions for females
N97.0 – Female infertility due to tubal obstruction
N80.1 – Endometriosis of ovary

Confirm Procedural Details:

The operative note should be a clear record of:

Abdominal incision and access
Identification and division of adhesions
Preservation of fallopian tubes and/or ovaries
Hemostasis and closure
Any intraoperative complications or technical challenges

Reimbursement Considerations:

Correct coding will allow payers to appreciate the complexity of the open procedure, distinguish between laparoscopic versus incidental adhesiolysis from open adhesiolysis, and ensure the procedure is properly reimbursed to reduce claim denials.

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By leveraging BillingFreedom's medical billing solutions for OBGYN practices, they can find the time to dedicate themselves to delivering exceptional patient care, with peace of mind that their billing is accurate, compliant, and optimized for higher reimbursements. We ensure that the complex procedures such as CPT 58740 are captured accurately, claims are processed efficiently and revenue opportunities are maximized. BillingFailure is a reliable ally for OBGYN practices, improving financial performance while minimizing administrative workload.

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