Yes, You Can Use 44180 With Unlisted Code 58999

By Author: erinarticle
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Here's a particular ob-gyn coding scenario that ob-gyn coders can take note of: My ob-gyn documented the following procedure: Excision granulation tissue vaginal cuff. Laparoscopy, extensive (45 minutes) lysis of adhesions of the sigmoid colon to posterior cul-de-sac. Scissors utilized to dissect lt. Inspection showed connection of the granulation tissue through the vagina into peritoneum. All granulation tissue was removed from vagina as well as inflammation and what looked like reaction to stitch. So how should you go about this particular situation?
Well, you should code the lysis of adhesions with 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]) and the removal of the granulation from the vaginal cuff (carried out vaginally) as 58999 (Unlisted procedure, female genital system [nonobstetrical]).
While reporting an unlisted procedure code, you should let the payer understand how to judge that your charge is reasonable based on the physician work.
It is better to check with your surgeon to see what procedure he'd like to compare this work to in ...
... order that you set your fee. You should also let the payer know an equal of the amount of estimated work. In order to do this, you should review your doctor's to note how the ob-gyn removed the granulation tissue.
If carried out by chemical cautery, you might compare the work to 17250 (Chemical cauterization of granulation tissue [proud flesh, sinus or fistula]). If done by destruction, say for instance using a laser by cryocautery you might compare the work to 57061 (Destruction of vaginal lesions[s]; simple [example laser surgery, electrosurgery, cryosurgery, chemosurgery]) or 57065 (Destruction of vaginal lesion[s]; extensive [example., laser surgery, electrosurgery, cryosurgery, chemosurgery]). If he debrided the area, you might look to 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less), and if he excised the tissue, you'd need to know the extent of the area removed and look to 11440-11446 (Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane ...) as a comparison as the vaginal canal would be consistent with a mucus membrane.
Do not try to code for the stitch removal since this service seems to be part of the adhesions involvement.
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