Can You Bill 58661 and 58662 Together?

Medical billing involves a complex framework of rules and guidelines, particularly when multiple procedures are performed during a single surgical session. This article aims to clarify the specific billing practices for CPT codes 58661, “Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy),” and 58662, “Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method.” It defines these codes and explains principles for combining them for billing purposes.

Understanding CPT Codes 58661 and 58662

CPT code 58661 describes a laparoscopic surgical procedure focused on the removal of adnexal structures, primarily the ovaries and fallopian tubes. This code encompasses procedures such as a partial or total oophorectomy (removal of ovaries) and salpingectomy (removal of fallopian tubes). Healthcare providers utilize this minimally invasive technique to address various gynecological issues, including ovarian cysts, ectopic pregnancies, or other conditions affecting these reproductive organs.

CPT code 58662 pertains to laparoscopic surgical procedures for the fulguration or excision of lesions found on the ovary, pelvic viscera, or peritoneal surface. Lesions can include abnormal growths, cysts, or tissue formations, often associated with conditions like endometriosis. Fulguration involves the destruction of tissue using an electric current, while excision means the removal of the tissue. This code is applicable when a surgeon addresses such lesions using laparoscopic methods.

Adhesions are abnormal fibrous bands of scar tissue that can form between organs within the abdominal or pelvic cavity. These bands often develop as a result of previous surgeries, infections, or inflammatory conditions such as endometriosis. Adhesions can cause chronic abdominal or pelvic pain, intestinal obstruction, or even infertility by restricting the normal movement of organs. Laparoscopic lysis of adhesions is the surgical process of breaking down or cutting away these scar tissues to alleviate symptoms and restore normal organ function. CPT 58662 specifically covers the removal or destruction of lesions, which may involve addressing adhesions if they are part of a lesion or are directly causing issues that necessitate their removal or destruction.

Fundamentals of Concurrent Procedure Billing

Billing for multiple surgical procedures performed during the same operative session necessitates an understanding of specific financial principles. One such principle involves procedure bundling, where certain services are considered integral to a primary procedure and are not separately billable. This approach acknowledges that many surgical procedures include pre-procedure, intra-procedure, and post-procedure work, and when multiple procedures occur in one encounter, there can be overlap in these components. Consequently, payers, including Medicare, often reimburse the highest-valued procedure at full price and reduce payment for subsequent procedures performed during the same session.

The National Correct Coding Initiative (NCCI) edits are a primary resource for bundling guidelines. Developed by the Centers for Medicare & Medicaid Services (CMS), NCCI edits identify code pairs that should not be billed together unless specific criteria are met. These edits aim to prevent inappropriate payments by bundling component codes into more inclusive services. If a provider reports two codes from an NCCI edit pair, the Column One code is typically eligible for payment, while the Column Two code may be denied unless an exception applies.

CPT modifiers play a crucial role in clarifying the circumstances of a procedure and can sometimes bypass NCCI edits when justified. Modifier 59, “Distinct Procedural Service,” is frequently used to indicate that a procedure or service was distinct or independent from other non-evaluation and management services performed on the same day. Its appropriate usage includes situations where procedures are performed at a different session, a different procedure or surgery, a different site or organ system, a separate incision/excision, a separate lesion, or a separate injury. However, Modifier 59 is one of the most frequently misused modifiers, and documentation must clearly support its application.

The X-modifiers (XE, XS, XP, XU) were introduced to provide greater specificity than Modifier 59 and should be used instead of Modifier 59 whenever possible. Modifier XE signifies a separate encounter, indicating a service was distinct due to occurring in a different session on the same date. Modifier XS denotes a separate structure, used when a service is performed on a different organ or anatomical structure. Modifier XP is for a separate practitioner, indicating a service distinct because it was performed by a different provider. Modifier XU represents an unusual, non-overlapping service, highlighting distinct procedures that do not typically occur together but are necessary for comprehensive patient care. These specific modifiers aim to reduce the improper use of Modifier 59 and improve claims processing accuracy.

Billing Guidance for CPT 58661 and 58662

When considering billing CPT codes 58661 and 58662 together, it is important to understand that per National Correct Coding Initiative (NCCI) edits, CPT 58662 (lysis of adhesions or excision of lesions) is often bundled with other major surgical procedures, including CPT 58661 (removal of adnexal structures). This bundling occurs because lysis of adhesions can be incidental, or a necessary step to gain access to the primary surgical site for the main procedure. The NCCI considers such services to be integral components of the primary surgery, meaning they are typically not separately billable.

Separate billing for CPT 58662 with CPT 58661 is possible only under specific circumstances that meet the criteria for a “distinct procedural service,” typically requiring the use of Modifier 59 or an appropriate X-modifier. For instance, if the lysis of adhesions is extensive and requires significant additional time and effort, beyond what is typical for gaining surgical access, it may qualify as a distinct service. An example might include adhesions causing widespread organ entanglement in areas separate from the immediate adnexal surgical field, necessitating a lengthy and complex dissection. This extensive work must be clearly documented to support separate billing.

Another scenario justifying separate billing is when the lysis of adhesions is performed in a different anatomical region from where the primary procedure (adnexal removal) takes place, or addresses a separate, non-contiguous lesion. For example, if adnexal structures are removed from one side of the pelvis (58661), and significant, unrelated adhesions are lysed from the opposite side or a distant part of the abdominal cavity (58662), without being incidental to the primary procedure, separate billing may be appropriate. The key is that the lysis of adhesions is not merely for exposure or incidental to the main surgery.

Furthermore, separate billing may be supported if the lysis of adhesions is performed due to a distinct diagnosis unrelated to the primary condition necessitating the adnexal structure removal. For instance, if the adnexal removal is for an ovarian cyst, but the adhesions are causing a separate, symptomatic bowel obstruction. While a different diagnosis is not always sufficient to justify Modifier 59, it strengthens the case for distinctness when combined with other factors like different anatomical sites or significant additional work. The medical record must clearly link the adhesions to this separate, distinct clinical issue.

Crucially, comprehensive documentation is required to support the separate billing of 58662 when performed with 58661. Operative notes must provide a detailed description of the extent and location of the adhesions, explicitly stating their severity and the challenges they presented. This includes documenting the specific anatomical sites involved and confirming that the adhesions were not merely incidental to gaining access for the adnexal surgery. Without this detailed operative narrative, claims for 58662 will likely be denied.

Documentation should also clearly articulate the significant additional time and effort required for the lysis of adhesions. This could involve specific time stamps or a narrative explaining the prolonged surgical duration directly attributable to the adhesiolysis. The operative report should clearly differentiate the work performed for the adnexal removal from the distinct, complex work of the adhesion lysis. Simply stating that adhesions were encountered is insufficient; their impact on the surgical complexity and duration must be evident.

A clear narrative explaining why the lysis was a separate and distinct procedure, and not merely incidental to the primary procedure or for exposure, is essential. This narrative should provide a robust clinical rationale, emphasizing that the adhesiolysis addressed a separate medical problem or involved work far exceeding what is considered typical for gaining access. Identification of any separate diagnosis specifically related to the adhesions, if applicable, further strengthens the justification for separate billing. Insufficient or vague documentation will invariably lead to denial of the 58662 charge, highlighting the importance of precise and thorough record-keeping.