Crystal's MCW Coder Hub⚕️CPT Code 58660 - Laparoscopy, Surgical; With Lysis of Adhesions (Salpingolysis, Ovariolysis)
📋 Full Code Description
Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)
This code reports a surgical laparoscopy in which the primary therapeutic intervention is the lysis (freeing) of adhesions involving the fallopian tubes (salpingolysis) and/or ovaries (ovariolysis). Adhesions are fibrous bands of scar tissue that abnormally tether these structures to each other, to the uterus, to the pelvic sidewall, to the bowel, or to the broad ligament — distorting normal pelvic anatomy and impairing organ mobility, tubal function, and oocyte transport.
The procedure is performed entirely through laparoscopic port sites under general anesthesia. After establishing pneumoperitoneum and gaining laparoscopic access, the surgeon systematically surveys the pelvis, identifies adhesive disease, and divides, excises, or ablates the adhesive bands using sharp dissection, blunt dissection, electrocautery (monopolar or bipolar), ultrasonic energy (harmonic scalpel), or laser — restoring normal pelvic anatomy to the greatest extent possible.
58660 specifically targets the adnexal structures — the fallopian tubes and ovaries — as the anatomical focus of the adhesiolysis. This distinguishes it from:
- 44180 — laparoscopic intestinal adhesiolysis (enterolysis)
- 58559 — intrauterine adhesiolysis via hysteroscopy (Asherman’s syndrome)
- 49320 — diagnostic laparoscopy (not therapeutic)
The code carries the critical “(separate procedure)” designation, which has extensive NCCI and bundling implications addressed in detail below. Per CPT Assistant (March 2003): 58660 may be reported in addition to the primary procedure only if dense/extensive adhesions are encountered that require effort beyond that ordinarily provided for the laparoscopic procedure performed. This is a key and frequently contested billing principle.
58660 covers adhesiolysis involving one or both fallopian tubes, one or both ovaries, or any combination thereof — it is reported as a single unit per operative session regardless of the number of adhesions lysed or the number of adnexal structures freed.
🔬 Anatomy and Pathophysiology of Adnexal Adhesions
| Feature | Detail |
|---|---|
| Fallopian tubes (oviducts) | 10-12 cm paired muscular tubes connecting the ovaries to the uterine cornua; responsible for ovum capture, sperm-egg transport, and fertilization; highly sensitive to peritubal adhesions |
| Ovaries | Paired gonads suspended by the ovarian ligament and infundibulopelvic (IP) ligament; adhesions can bury the ovary against the broad ligament, uterus, or sigmoid colon (“kissing ovaries”) |
| Salpingolysis | Division/release of adhesions encasing, distorting, or kinking the fallopian tube; tube must remain patent (open) for natural conception to be possible |
| Ovariolysis | Division/release of adhesions that tether or bury the ovary; critical for normal ovulation and oocyte capture by the fimbriated tube end |
| Primary adhesion causes | Prior pelvic surgery (most common: appendectomy, C-section, myomectomy, ovarian cystectomy), endometriosis, PID/salpingitis, ruptured ovarian cyst, pelvic peritonitis |
| Consequences | Chronic pelvic pain, dyspareunia, dysmenorrhea, tubal-factor infertility, anovulatory cycles due to buried ovary, tubal ectopic pregnancy risk |
| AFS/ASRM Adhesion Scoring | Adhesions classified as filmy (thin, transparent) or dense (thick, vascularized) and as involving tubes vs. ovaries; scoring determines surgical complexity and prognosis for fertility |
| Recurrence | Adhesions reform in 50-85% of patients after adhesiolysis; anti-adhesion barriers (Interceed, Seprafilm) may reduce reformation |
🏥 Code Placement in the CPT Hierarchy
| Level | Description |
|---|---|
| Section | Surgery |
| Subsystem | Female Genital System |
| Sub-subsection | Oviduct/Ovary |
| Procedure type | Laparoscopic Procedures on the Oviduct/Ovary |
| Code range | 58660-58679 |
| Code | 58660 |
🌳 Code Tree / Family
Surgical Procedures — Female Genital System
│
├── LAPAROSCOPIC Procedures on the Oviduct/Ovary
│ │
│ ├── 58660 — Lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) ← THIS CODE
│ │ ↳ Adnexal adhesiolysis only; no excision, fulguration, or removal
│ │ ↳ wRVU ~8.03 | Global: 090 days | Separate procedure
│ │ ↳ Cannot bill alongside 58661, 58662 without strict modifier support
│ │
│ ├── 58661 — With removal of adnexal structures (partial/total oophorectomy and/or salpingectomy)
│ │ ↳ Excision of ovary and/or fallopian tube
│ │ ↳ 58660 is NCCI Column 2 edit for 58661
│ │ ↳ wRVU ~9.47 | Global: 090 days
│ │
│ ├── 58662 — With fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface
│ │ ↳ Endometriosis excision/fulguration
│ │ ↳ 58660 is NCCI Column 2 edit for 58662
│ │ ↳ wRVU ~12.47 | Global: 090 days
│ │
│ ├── 58670 — With fulguration of oviducts (with or without transection)
│ │ ↳ Tubal sterilization via fulguration/electrocautery
│ │
│ ├── 58671 — With occlusion of oviducts by device (band, clip, Falope ring)
│ │ ↳ Mechanical tubal sterilization
│ │
│ ├── 58672 — With fimbrioplasty
│ │ ↳ Repair of fimbriated tube end
│ │
│ ├── 58673 — With salpingostomy (salpingoneostomy)
│ │ ↳ Creation of new tubal ostium; hydrosalpinx treatment
│ │
│ └── 58679 — Unlisted laparoscopy procedure, oviduct, ovary
│
├── OPEN Counterpart
│ └── 58740 — Lysis of adhesions (salpingolysis, ovariolysis), OPEN approach
│ ↳ Open abdominal counterpart to 58660
│ ↳ Same "separate procedure" rule applies
│ ↳ wRVU ~8.64 | Global: 090 days
│
├── RELATED LAPAROSCOPIC Adhesiolysis Codes (Non-Gynecologic)
│ ├── 44180 — Laparoscopic enterolysis (intestinal adhesions) (separate procedure)
│ │ ↳ Intestinal adhesions; NOT adnexal adhesions
│ │ ↳ May be co-reported with 58660 if distinct anatomic sites
│ │
│ └── 49320 — Diagnostic laparoscopy, abdomen, peritoneum, omentum (separate procedure)
│ ↳ ALWAYS bundled into 58660; never separately reported same session
│
└── HYSTEROSCOPIC Intrauterine Adhesiolysis
└── 58559 — Hysteroscopy, surgical; with lysis of intrauterine adhesions
↳ Asherman's syndrome; intrauterine adhesions via hysteroscope
↳ Different anatomic target; may be co-reported with 58660 if both performed
📌 CPT Rule: Surgical laparoscopy always includes diagnostic laparoscopy. 49320 is inherently bundled into 58660 and is never separately reportable in the same operative session.
⚙️ Technical Details
| Field | Detail |
|---|---|
| Global Period | 090 — 90-day global surgical package (major surgery) |
| wRVU (Work RVU) | ~8.03 (verify via CMS MPFS Addendum B for current value) |
| Total RVU (Facility, est.) | ~11.00-12.50 (estimated; geographically adjusted) |
| 2025 Medicare MPFS Non-Facility Payment | ~$680 (national average non-facility; geographically adjusted) |
| 2025 Medicare MPFS Facility Payment | Lower than non-facility; varies by MAC locality |
| PC/TC Indicator | N/A — surgical procedure; no professional/technical split |
| Assistant Surgeon Payable | ❌ Not typically payable by Medicare (indicator 0 for most payers). This is a laparoscopic procedure typically performed by a single surgeon; an assistant is not considered medically necessary by default. Private payers and some commercial insurers may allow assistant surgeon billing with documented medical necessity. |
| Co-Surgeon Payable | ❌ Generally no |
| Bilateral Indicator | 0 — Not applicable; code covers bilateral adnexal adhesiolysis as a single unit |
| Separate Procedure Designation | ✅ Yes — “(separate procedure)” designation per CPT |
| Major Surgery | ✅ Yes — 90-day global period |
| MUE | 1 unit per date of service |
| Usual Place of Service | POS 21 (Inpatient Hospital), POS 22 (Outpatient Hospital), POS 24 (ASC) |
| Anesthesia | General endotracheal; administered by separate anesthesiology team |
| Typical OR Time | 45 minutes-2+ hours, depending on adhesion extent, density, and anatomy |
| Conversion Factor (2025) | $32.35 |
| Prior Authorization | Commonly required by commercial payers; document medical necessity (infertility workup, unresponsive chronic pelvic pain, imaging findings) |
🔬 Step-by-Step Operative Overview
PATIENT — Adnexal Adhesive Disease (Salpingolysis and/or Ovariolysis)
│
▼
STEP 1: Positioning
- Patient placed in dorsal lithotomy position (modified lithotomy)
- Legs in Allen stirrups; arms tucked
- Uterine manipulator (e.g., RUMI, Koh-Efficient) placed transcervically
to allow uterine mobility during pelvic survey
│
▼
STEP 2: Insufflation and Port Placement
- Veress needle or open (Hasson) technique at umbilicus
- CO₂ insufflation to 12-15 mmHg pneumoperitoneum
- 10-12mm umbilical port for laparoscope (0° or 30° camera)
- Typically 2-3 additional 5mm ports: left lateral, right lateral,
suprapubic — for instruments
- Patient placed in steep Trendelenburg (30°) to shift bowel cephalad
and expose pelvis
│
▼
STEP 3: Survey of the Pelvis
- Systematic inspection of:
• Uterus (size, position, contour, fibroids)
• Bilateral fallopian tubes (caliber, fimbriae, peritubal adhesions)
• Bilateral ovaries (mobility, endometriomas, periovarian adhesions)
• Cul-de-sac (posterior cul-de-sac, obliteration = endometriosis staging)
• Bladder peritoneum (anterior adhesions, C-section shelf)
• Pelvic sidewalls, broad ligament, uterosacral ligaments
• Bowel surface (sigmoid, appendix)
• Omentum (any adherence)
- Adhesion type and extent characterized (filmy vs. dense; avascular vs.
vascular; ovary-to-uterus, tube-to-ovary, adnexa-to-sidewall, etc.)
│
▼
STEP 4: Adhesiolysis
- Adhesive bands placed on traction with laparoscopic forceps/grasper
- Sharp excision/division using:
• Laparoscopic scissors (preferred for filmy, avascular adhesions)
• Monopolar hook cautery (for vascular adhesions; hemostasis)
• Bipolar forceps (coagulate then divide vascular pedicles)
• Harmonic scalpel (combined cutting/coagulation for complex bands)
• CO₂ or KTP laser (less common; highly precise for delicate structures)
- Free the fallopian tube from the ovary, uterus, pelvic sidewall, bowel
as applicable
- Free the ovary from the broad ligament, pelvic sidewall, cul-de-sac
as applicable
- Care taken to avoid thermal injury to tube serosa (impairs ciliary function)
- Hemostasis confirmed after each adhesion band divided
│
▼
STEP 5: Chromotubation (Optional; Fertility Cases)
- If bilateral tube patency confirmation is the goal (infertility surgery):
• Dilute methylene blue or indigo carmine dye injected through the
uterine manipulator transcervically
• Laparoscopic observation for dye spill from each fimbriated end
• Document bilateral, unilateral, or no dye spill
• Cannot bill separately — included in the service
│
▼
STEP 6: Anti-Adhesion Barrier (Optional)
- Interceed (oxidized regenerated cellulose) or other barrier placed
over adhesiolysis sites when applicable
- Not separately reportable — included in the service
│
▼
STEP 7: Irrigation and Hemostasis Check
- Pelvic irrigation with warm saline
- Final hemostasis check at all dissection sites
│
▼
STEP 8: Closure
- CO₂ deflation; instruments and ports removed
- Fascial closure for ≥10mm ports (umbilical)
- Skin closure with suture or adhesive strips
- Uterine manipulator removed from vagina
✅ What This Code Includes
- Establishment of pneumoperitoneum (CO₂ insufflation)
- Placement of laparoscopic trocars and ports
- Complete diagnostic laparoscopic survey of the pelvis (included — not separately reportable)
- Systematic identification and characterization of adnexal adhesions (tubes and/or ovaries)
- Adhesiolysis using any combination of: sharp dissection, blunt dissection, monopolar cautery, bipolar cautery, ultrasonic/harmonic energy, or laser
- Hemostasis of bleeding points encountered during adhesiolysis
- Chromotubation with dilute dye (tubal patency check) — when performed as part of the same session
- Anti-adhesion barrier placement — when applied as part of the same session
- Irrigation and final hemostasis survey
- Port-site closure including fascial repair of ≥10mm ports
- 90-day post-operative global surgical package (all related post-op visits for 90 days from day of surgery)
- Coverage for adhesiolysis involving one or both tubes, one or both ovaries, or any combination — single unit regardless
❌ What This Code Does NOT Include / Excludes
- Open approach adhesiolysis — that is 58740 (open salpingolysis/ovariolysis); cannot combine open and laparoscopic for same adnexal adhesions
- Intestinal adhesiolysis — 44180 (laparoscopic enterolysis) is the appropriate code for bowel/intestinal adhesions; may be separately reportable alongside 58660 if bowel adhesions at a genuinely distinct anatomic site require separate and documented surgical work
- Intrauterine adhesions (Asherman’s) — 58559 (hysteroscopic adhesiolysis) — may be co-reported with 58660 if both are performed and both are documented as distinct medically necessary procedures
- Diagnostic laparoscopy 49320 — inherently included in all surgical laparoscopic procedures; cannot be separately reported in the same session
- Adnexal structure removal — if an ovary or fallopian tube is excised, the appropriate code is 58661; 58660 covers lysis only, not excision or resection
- Endometriosis fulguration/excision — that is 58662; adhesiolysis incidental to endometriosis treatment is bundled into 58662 and cannot be separately reported as 58660 without modifier support
- Fimbrioplasty — 58672 (repair of the fimbriated tube end); a separate code if performed
- Salpingostomy/neosalpingostomy — 58673 (creating a new tubal ostium for hydrosalpinx); separate code
- Tubal sterilization — 58670 (fulguration) or 58671 (mechanical occlusion); separate codes
- Oophorocystectomy (ovarian cystectomy) — no cyst removal is included in 58660; requires additional coding
- Anesthesia — reported separately by anesthesiology
- Specimen pathology — laboratory interpretation billed separately by the pathologist if any tissue is excised incidentally
📌 The “Separate Procedure” Rule — The Most Critical Concept for 58660
Per CPT guidelines, CMS NCCI Policy Manual, and CPT Assistant (March 2003), the “separate procedure” designation on 58660 governs its billing in nearly all clinical scenarios:
“Code 58660 can be reported in addition to the primary procedure only if dense/extensive adhesions are encountered that require effort beyond that ordinarily provided for the laparoscopic procedure. Lysis of adhesions typically is included as part of the laparoscopic surgery performed. As code 58660 is designated as a separate procedure, modifier -59, Distinct Procedural Service, should be appended in order to indicate that code 58660 is not considered an integral component of the other procedure(s).” — CPT Assistant, March 2003
Practical Application Table
| Clinical Scenario | Correct Billing |
|---|---|
| Adhesiolysis is the only procedure performed (no other intervention) | 58660 alone; no additional modifier needed |
| Adhesiolysis performed as component of laparoscopic salpingo-oophorectomy (58661) | Do NOT bill 58660 — it is a Column 2 NCCI edit for 58661 |
| Adhesiolysis performed as component of endometriosis excision (58662) | Do NOT bill 58660 — it is a Column 2 NCCI edit for 58662 |
| Adhesiolysis performed as component of laparoscopic hysterectomy | Do NOT bill 58660 — bundle into the hysterectomy code; if extensive, use -22 on hysterectomy code |
| Adhesiolysis is extensive, adds significant OR time, separate from primary procedure’s ordinary component | Bill 58660 -59 alongside primary code only with strong operative documentation of distinct, extensive work |
| Dense adnexal adhesiolysis requiring >30 min adds to a more complex procedure | Do NOT separately bill 58660; append -22 to the primary procedure code and document complexity in narrative |
| Adhesiolysis performed at a distinct anatomic site from the primary procedure (e.g., right adnexa freed vs. left oophorectomy) | May bill 58660 -59 — distinct site, distinct therapeutic intent; document thoroughly |
| 58660 at different operative session from related procedure | 58660 alone; separate session = separate reporting; use appropriate global period modifiers (-58, -78, -79) |
⚠️ CPT Assistant Principle:
“Lysis of adhesions is included in almost all surgeries, whether laparoscopic or open.” The default is bundling, not separate billing. The burden of documentation to unbundle is on the provider.
🔢 NCCI / Bundling Edits
Per CMS NCCI, 58660 is a Column 2 (component) edit for the following codes, meaning it bundles into the primary procedure and cannot be separately reported without modifier support:
| Code | Description | Edit Type | Notes |
|---|---|---|---|
| 58661 | Laparoscopic removal of adnexal structures | Column 1/Column 2 — 58660 bundles into 58661 | ACOG: “Cannot be reported with 58661 under any circumstances” |
| 58662 | Laparoscopic fulguration/excision of lesions | Column 1/Column 2 — 58660 bundles into 58662 | Adhesiolysis for endometriosis is inherent to 58662 |
| 44180 | Laparoscopic enterolysis | Mutual relationship — may report both if truly distinct anatomic sites (pelvic adnexa vs. intestinal/bowel adhesions) with -59; document carefully | |
| 49320 | Diagnostic laparoscopy | 49320 always bundles into any surgical laparoscopy; cannot bill diagnostic alongside 58660 same session | |
| 58672 | Fimbrioplasty | Relationship edit — fimbrioplasty often accompanies adhesiolysis; document distinct work if billing both | |
| 58673 | Salpingostomy | Relationship edit — neosalpingostomy often accompanies tubal adhesiolysis |
ACOG Official Guidance (American College of Obstetricians and Gynecologists):
“Services that cannot be reported with 58661 under any circumstances: Lysis of adhesions (44005, 44180, 58660, and 58740).”
This is an absolute restriction — no modifier override, no exception documentation — when 58661 is the primary code and adhesiolysis is simply what was required to access and remove the adnexa.
Caution
⚠️ Always verify the full CMS NCCI PTP edit table for current edits. NCCI edits are updated quarterly.
🏷️ Applicable Modifiers
| Modifier | Name | Application to 58660 |
|---|---|---|
| -59 | Distinct Procedural Service | Most important modifier for 58660 — appended to 58660 when it is reported alongside another laparoscopic procedure and the adhesiolysis was dense, extensive, time-consuming, and at a genuinely distinct anatomic site or therapeutic intent beyond what is routine for the primary procedure. Requires detailed operative documentation. Do NOT use as a reflexive override for NCCI edits without documented distinct service. |
| -XS | Separate Structure | Preferred by some payers over -59; more specific — indicates a different anatomic structure was involved. Use when adnexal adhesiolysis (right ovary) is truly separate from another procedure (left salpingectomy, for example). |
| -22 | Increased Procedural Services | Appended to the primary procedure code (NOT to 58660) when the adhesiolysis was so extensive, complex, and time-consuming that it substantially increased the work of the primary procedure beyond the typical service. Requires a detailed narrative in the operative report describing adhesion density, vascularity, extent, and operative time attributable to adhesiolysis. CPT Assistant specifically endorses this approach when 58660 cannot be separately billed. |
| -57 | Decision for Surgery | Appended to the E/M code (NOT 58660) when the decision for surgery is made at the same visit as the procedure for a major surgery (90-day global). Applied to the E/M on the day before or day of surgery. |
| -52 | Reduced Services | When adhesiolysis is initiated but cannot be completed (e.g., dense frozen pelvis prevents safe laparoscopic dissection and the decision is made to stop rather than risk injury) |
| -53 | Discontinued Procedure | When the procedure is abandoned after initiation due to patient safety concerns before any meaningful therapeutic work is completed |
| -54 | Surgical Care Only | When the operating gynecologist performs the procedure but transfers post-operative care to another provider; 90-day global splits accordingly |
| -55 | Postoperative Management Only | When a provider assumes post-operative management from the operating gynecologist during the 90-day global period |
| -58 | Staged/Related Procedure During Global Period | When a related planned procedure is performed during the 90-day global period (e.g., planned second-look laparoscopy, hysteroscopy for infertility evaluation after adhesiolysis) |
| -62 | Two Surgeons | When the complexity of concurrent pelvic pathology requires two surgeons of different specialties (e.g., gynecologist + colorectal surgeon for sigmoid adhesiolysis + adnexal adhesiolysis simultaneously); each surgeon bills their own work |
| -78 | Unplanned Return to OR, Same Physician | When the patient returns to the OR during the 90-day global period for a related complication (e.g., hemoperitoneum from bleeding adhesiolysis site; reformation of adhesions causing acute obstruction) |
| -79 | Unrelated Procedure During Global Period | For a new, unrelated procedure performed during the 90-day global period |
| -80 | Assistant Surgeon | Not routinely payable by Medicare for 58660; payer-specific verification required before billing |
| -AS | PA/NP/CNS as Assistant Surgeon | Non-physician practitioner assistant; payer-specific |
🏥 MS-DRG Applicability
CPT 58660 is an outpatient/professional billing code. In the inpatient setting, procedures are reported using ICD-10-PCS, not CPT. 58660 is most commonly performed as an outpatient or ASC procedure and will not typically be the driver of an inpatient DRG. When it is performed during an inpatient stay (e.g., concurrent with another inpatient gynecologic procedure), it groups within MDC 13 — Diseases and Disorders of the Female Reproductive System.
ICD-10-PCS Equivalent Codes for Inpatient Laparoscopic Adnexal Adhesiolysis
ICD-10-PCS root operation: Release (N) — “Freeing a body part from an abnormal physical constraint by cutting or by the use of force.” The body part value is specific to the structure being released (fallopian tube or ovary) and the laterality.
| ICD-10-PCS Code | Description |
|---|---|
| 0UN54ZZ | Release Right Fallopian Tube, Percutaneous Endoscopic Approach |
| 0UN64ZZ | Release Left Fallopian Tube, Percutaneous Endoscopic Approach |
| 0UN74ZZ | Release Bilateral Fallopian Tubes, Percutaneous Endoscopic Approach |
| 0UN04ZZ | Release Right Ovary, Percutaneous Endoscopic Approach |
| 0UN14ZZ | Release Left Ovary, Percutaneous Endoscopic Approach |
| 0UN24ZZ | Release Bilateral Ovaries, Percutaneous Endoscopic Approach |
📌 If multiple structures are released (e.g., bilateral tubes AND bilateral ovaries), multiple ICD-10-PCS codes are assigned — one per distinct body part released. Each code reflects the specific structure freed.
MS-DRG Groupings
When laparoscopic adnexal adhesiolysis is performed as the principal inpatient procedure (rare), the case groups within MDC 13:
| MS-DRG | Description | Notes |
|---|---|---|
| 742 | Uterine and Adnexa Procedure for Non-Malignancy with CC/MCC | Laparoscopic adnexal adhesiolysis + complicating condition (e.g., PID, sepsis, CKD) |
| 743 | Uterine and Adnexa Procedure for Non-Malignancy without CC/MCC | Straightforward adnexal adhesiolysis, no significant comorbidities |
| 760 | Menstrual and Other Female Reproductive System Disorders with CC/MCC | When no qualifying O.R. procedure; medical management of pelvic adhesive disease |
| 761 | Menstrual and Other Female Reproductive System Disorders without CC/MCC | Same; no O.R. procedure |
| 732 | Other Female Reproductive System O.R. Procedures with CC | When the case groups to a miscellaneous female GYN OR DRG |
| 733 | Other Female Reproductive System O.R. Procedures without CC/MCC |
Estimated 2025 IPPS Payments:
| MS-DRG | Geo Mean LOS | Rel. Weight (est.) | Est. National Payment |
|---|---|---|---|
| 742 (w/ CC/MCC) | ~3.5 days | ~2.05 | ~13,000 |
| 743 (w/o CC/MCC) | ~1.8 days | ~1.21 | ~8,000 |
💡 The principal ICD-10-CM diagnosis drives MDC/DRG assignment much more significantly than the procedure code. Accurate, specific diagnosis coding — particularly distinguishing infertility, endometriosis stage, and infection — substantially impacts DRG grouping and reimbursement.
🩺 Associated ICD-10-CM Diagnosis Codes
💡 Coding tip: Code the clinical indication for the adhesiolysis as the principal diagnosis — not the adhesions themselves as a secondary finding. Adhesions (N73.6, N99.4, K66.0) are commonly listed as a secondary or etiology code. The primary diagnosis should reflect the clinical consequence (infertility, pelvic pain, obstruction) or underlying disease (endometriosis, PID) driving the surgery.
🩹 Pelvic Adhesions (Core Diagnosis Codes)
| ICD-10-CM | Description | HCC | CC/MCC | Notes |
|---|---|---|---|---|
| N73.6 | Female pelvic peritoneal adhesions (postinfective) | None | CC | Adhesions resulting from prior infection (PID, salpingitis); CC status |
| N99.4 | Postprocedural pelvic peritoneal adhesions | None | CC | Post-surgical adhesions (C-section, myomectomy, appendectomy scar); CC |
| K66.0 | Peritoneal adhesions (postprocedural or postinfection) | None | CC | General peritoneal adhesion code; use when pelvic adhesions involve bowel or peritoneum in addition to adnexa; CC |
| N73.5 | Female pelvic peritoneal adhesions (chronic) | None | CC | Chronic pelvic adhesive disease, unspecified cause |
🌸 Endometriosis (Extremely Common Indication)
| ICD-10-CM | Description | HCC | CC/MCC | Notes | |
|---|---|---|---|---|---|
| N80.00 | Endometriosis of uterus, unspecified | None | None | ||
| N80.01 | Superficial endometriosis of uterus | None | None | New 2023 specificity code | |
| N80.03 | Adenomyosis of uterus | None | None | ||
| N80.101 | Endometriosis of right ovary, unspecified depth | None | None | ||
| N80.102 | Endometriosis of left ovary, unspecified depth | None | None | ||
| N80.103 | Endometriosis of bilateral ovaries, unspecified depth | None | None | ||
| N80.111 | Superficial endometriosis of right ovary | None | None | ||
| N80.121 | Deep endometriosis of right ovary | None | None | ||
| N80.201 | Endometriosis of right fallopian tube, unspecified depth | None | None | ||
| N80.202 | Endometriosis of left fallopian tube, unspecified depth | None | None | ||
| N80.211 | Superficial endometriosis of right fallopian tube | None | None | ||
| N80.221 | Deep endometriosis of right fallopian tube | None | None | ||
| N80.30 | Endometriosis of pelvic peritoneum, unspecified | None | None | ||
| N80.31 | Endometriosis of anterior cul-de-sac | None | None | ||
| N80.32 | Endometriosis of posterior cul-de-sac | None | None | Obliterated cul-de-sac = severe/Stage IV endometriosis | |
| N80.40 | Endometriosis of rectovaginal septum, unspecified | None | None | ||
| N80.9 | Endometriosis, unspecified | None | None | Avoid when specific site is documented |
🔬 Pelvic Inflammatory Disease / Salpingitis / Oophoritis
| ICD-10-CM | Description | HCC | CC/MCC | Notes |
|---|---|---|---|---|
| N70.01 | Acute salpingitis | None | None | Tubal infection; major cause of adnexal adhesions |
| N70.02 | Acute oophoritis | None | None | Ovarian infection |
| N70.03 | Acute salpingitis and oophoritis | None | None | |
| N70.11 | Chronic salpingitis | None | None | Chronic tubal infection → adhesions |
| N70.12 | Chronic oophoritis | None | None | |
| N70.13 | Chronic salpingitis and oophoritis | None | None | |
| N70.91 | Salpingitis, unspecified | None | None | |
| N70.93 | Salpingitis and oophoritis, unspecified | None | None | |
| N73.0 | Acute parametritis and pelvic cellulitis | None | CC | |
| N73.1 | Chronic parametritis and pelvic cellulitis | None | None | |
| N74 | Female pelvic inflammatory disorders in diseases classified elsewhere | None | None | Secondary code when PID is due to STI (code STI first) |
👶 Female Infertility (Extremely Common Indication for 58660)
| ICD-10-CM | Description | HCC | CC/MCC | Notes |
|---|---|---|---|---|
| N97.0 | Female infertility associated with anovulation | None | None | |
| N97.1 | Female infertility of tubal origin | None | None | Most common infertility code for 58660 — tubal adhesions/occlusion as cause |
| N97.2 | Female infertility of uterine origin | None | None | |
| N97.8 | Female infertility of other origin | None | None | Ovarian-origin infertility when ovary is the primary target |
| N97.9 | Female infertility, unspecified | None | None | Use only when origin truly undetermined |
| Z31.41 | Encounter for fertility testing | None | None | Secondary code; when adhesiolysis is performed as part of infertility workup |
| Z31.69 | Encounter for other general counseling and advice on procreation | None | None | Secondary code |
🩸 Chronic Pelvic Pain (Common Presenting Symptom)
| ICD-10-CM | Description | HCC | CC/MCC | Notes |
|---|---|---|---|---|
| N94.89 | Other specified conditions associated with female genital organs and menstrual cycle | None | None | Includes pelvic congestion syndrome and chronic pelvic pain NOS in female context |
| R10.2 | Pelvic and perineal pain | None | None | Use when chronic pelvic pain is a symptom and definitive diagnosis not yet confirmed; avoid once adhesions are confirmed — use the adhesion/endometriosis code instead |
| G89.29 | Other chronic pain | None | None | When chronic pain syndrome is separately documented |
| G89.28 | Other chronic postprocedural pain | None | None | When chronic pelvic pain is documented as post-surgical |
| N94.10 | Unspecified dyspareunia | None | None | Pain with intercourse from adhesive disease |
| N94.11 | Superficial (introital) dyspareunia | None | None | |
| N94.12 | Deep dyspareunia | None | None | Deep dyspareunia from posterior cul-de-sac adhesions/endometriosis |
| N94.3 | Premenstrual tension syndrome | None | None | |
| N94.6 | Dysmenorrhea, unspecified | None | None | Painful menstruation from adhesions/endometriosis |
🏥 Hydrosalpinx and Tubal Occlusion
| ICD-10-CM | Description | HCC | CC/MCC | Notes |
|---|---|---|---|---|
| N70.11 | Chronic salpingitis | None | None | Underlying cause of hydrosalpinx |
| N97.1 | Female infertility of tubal origin | None | None | Tubal factor infertility from hydrosalpinx/occlusion |
| Q50.6 | Other congenital malformations of fallopian tube and broad ligament | None | None | Congenital adhesive disease (rare) |
🧬 Ovarian Conditions Complicated by Adhesions
| ICD-10-CM | Description | HCC | CC/MCC | Notes |
|---|---|---|---|---|
| N83.201 | Unspecified ovarian cyst, right side | None | None | Ovarian cysts with periovarian adhesions |
| N83.202 | Unspecified ovarian cyst, left side | None | None | |
| N83.203 | Unspecified ovarian cyst, bilateral | None | None | |
| N83.09 | Other and unspecified follicular cyst of ovary | None | None | |
| N83.51 | Torsion of ovary and ovarian pedicle, right side | None | None | Ovarian torsion with adhesive sequelae |
| N83.52 | Torsion of ovary and ovarian pedicle, left side | None | None |
🔖 History and Z-Codes (Secondary Codes)
| ICD-10-CM | Description | HCC | CC/MCC | Notes |
|---|---|---|---|---|
| Z87.42 | Personal history of other diseases of the female genital tract | None | None | Prior PID, endometriosis if in remission |
| Z30.09 | Encounter for other contraceptive management | None | None | When tubal sterilization reversal follow-up is concurrent |
| Z31.41 | Encounter for fertility testing | None | None | Concurrent with infertility-related adhesiolysis |
| Z98.890 | Other specified postprocedural states | None | None | Post-surgical state relevant to adhesion etiology |
| Z53.31 | Laparoscopic surgical procedure converted to open | None | None | When 58660 was attempted laparoscopically but converted; secondary code |
🎯 HCC (Hierarchical Condition Category) Notes
⚕️ HCC categories apply to ICD-10-CM diagnosis codes only — not CPT codes.
Key Observations for 58660-Related Encounters
| HCC | Category | Relevant Codes | RAF Impact |
|---|---|---|---|
| HCC 12 | Metastatic Cancer and Acute Leukemia | If adhesions are secondary to prior gynecologic malignancy treatment | ~2.647 |
| HCC 23 | Other Significant Endocrine and Metabolic Disorders | Rarely applicable unless metabolic disorder drives adhesion pathology | Moderate |
| HCC 11 | Colorectal/Anal Cancers | If colorectal malignancy history drives adhesions | ~0.670 |
Critical HCC observations for 58660 encounters:
- The core diagnosis codes for 58660 — pelvic adhesions (N73.6, N99.4), endometriosis (N80.x), and female infertility (N97.x) — do not carry CMS-HCC v28 weight. This is a primarily non-HCC procedure from a risk-adjustment standpoint.
- Where HCC opportunity does exist is in thorough coding of comorbidities present at the time of surgery: CKD (N18.x, HCC 138), diabetes with complications (E11.3xx, HCC 38), prior malignancy history impacting the surgical plan.
- For inpatient cases, the CC/MCC status of secondary diagnoses matters significantly to DRG assignment. Notably, N73.6 (female pelvic peritoneal adhesions, postinfective) and N99.4 (postprocedural pelvic peritoneal adhesions) both qualify as CC, shifting the DRG from 743 → 742 and increasing reimbursement materially.
- When 58660 is performed in the context of a patient with prior gynecologic malignancy (e.g., post-treatment adhesions after ovarian cancer debulking), the malignancy or personal history code should be carefully evaluated for HCC eligibility and proper sequencing.
💡 Who Performs 58660 and Why?
| Specialty | Common Indications |
|---|---|
| Gynecology (General) | Post-surgical pelvic adhesions, pelvic pain evaluation/treatment, PID sequelae |
| Reproductive Endocrinology & Infertility (REI) | Tubal-factor infertility (adhesions as cause), pre-IVF evaluation, tubal patency restoration |
| Minimally Invasive Gynecologic Surgery (MIGS) | Complex endometriosis-associated adhesions, frozen pelvis, Stage III/IV endometriosis |
| Gynecologic Oncology | Post-treatment adhesiolysis after cytoreductive surgery; adhesions complicating surveillance laparoscopy |
| Urogynecology | Pelvic adhesions encountered during reconstructive pelvic floor procedures |
📋 Required Operative Report Elements for 58660
A compliant and audit-defensible operative report for 58660 must include:
- Pre-operative diagnosis — specific clinical indication (e.g., “bilateral adnexal adhesions, infertility, endometriosis stage II”)
- Post-operative diagnosis — confirmed findings (may differ from pre-op; specify what was found)
- Explicit naming of the procedure — “laparoscopic salpingolysis” and/or “laparoscopic ovariolysis” must be stated
- Anesthesia type and patient positioning
- Port placement — number, location, sizes
- Systematic pelvic survey — all structures inspected and findings documented for each (uterus, bilateral tubes, bilateral ovaries, cul-de-sacs, pelvic sidewalls, bowel, omentum)
- Adhesion characterization — for each adhesion band/site:
- Surgical technique — instrument(s) and energy modality used for each adhesion
- Chromotubation results — if performed (bilateral spill? unilateral? no spill?)
- Anti-adhesion barrier — type and location if applied
- Hemostasis — confirmed after each adhesion divided
- Final anatomical assessment — are tubes freely mobile? Are fimbriae patent? Are ovaries freely mobile?
- Complications — none or described (inadvertent enterotomy, bowel serosal tear, bleeding, ureteral proximity noted)
- Closure — port removal, fascial closure (umbilical if ≥10mm), skin closure technique
- Operative time — total; if applicable, time attributable specifically to adhesiolysis (critical for modifier -22 support)
⚠️ If 58660 is being co-reported alongside another laparoscopic procedure with modifier -59 or -22, the operative note must also include: a narrative statement distinguishing the adhesiolysis from the primary procedure, documentation that the adhesiolysis was beyond the ordinary requirements of the primary procedure, and ideally the time specifically spent on adhesiolysis.
🧾 Coding Examples
Example 1 — Adhesiolysis as the Sole Procedure (Infertility)
A 34-year-old female with primary infertility (tubal factor suspected on HSG) undergoes laparoscopic evaluation. Surgery reveals dense bilateral peritubal adhesions with both fallopian tubes adherent to the posterior broad ligament, preventing normal fimbrial mobility. Ovariolysis not required — ovaries are freely mobile. Bilateral salpingolysis performed using laparoscopic scissors and harmonic shears. Post-adhesiolysis chromotubation confirms bilateral dye spill. No other pathology encountered.
CPT: 58660 ICD-10-CM: N97.1 (female infertility of tubal origin), N73.6 (female pelvic peritoneal adhesions, postinfective) Modifier: None needed (sole procedure) Note: Post-op counseling and infertility management are separately billable E/M services
Example 2 — Adhesiolysis Alongside Endometriosis Excision (Bundled — Modifier -22)
A 29-year-old with known Stage III endometriosis undergoes laparoscopic surgery. Extensive dense pelvic adhesions are encountered from bilateral ovaries to the posterior broad ligament and sigmoid colon. Adhesiolysis required 55 minutes before the surgical field was adequately exposed for endometriosis excision. Afterward, endometriosis lesions on the peritoneum and right ovarian fossa are excised (58662). Total OR time: 3 hours 15 minutes.
CPT: 58662 -22 (extensive adhesiolysis substantially exceeded ordinary work for endometriosis excision) Do NOT add: 58660 — it is a Column 2 NCCI edit for 58662 and cannot be separately reported; use -22 on 58662 instead ICD-10-CM: N80.30 (endometriosis of pelvic peritoneum), N80.101 (endometriosis of right ovary), N73.6 (pelvic peritoneal adhesions) Documentation required for -22: Operative narrative must state adhesions were dense, vascular, and required 55 minutes of dissection before the operative field was accessible; operative time documentation required
Example 3 — Distinct Adnexal Adhesiolysis Alongside Contralateral Salpingectomy
A 38-year-old female undergoes laparoscopic left salpingectomy for hydrosalpinx (58661 -LT). Separately, the right adnexa is found to be buried in dense adhesions from a prior right-sided appendectomy. Extensive right ovariolysis and salpingolysis required to free the right ovary and tube from the right pelvic sidewall. This adhesiolysis involved a genuinely distinct anatomic site (right adnexa) from the primary procedure (left salpingectomy).
CPT: 58661 -LT + 58660 -59 -RT Rationale: Distinct anatomic site (right vs. left adnexa), distinct pathology (adhesions vs. hydrosalpinx), separate and extensive documented surgical work — supports -59 billing ICD-10-CM: N70.11 (chronic salpingitis — left, hydrosalpinx), N73.6 (pelvic peritoneal adhesions — right) ⚠️ Risk: NCCI edit exists between 58661 and 58660; this will trigger an edit review. Documentation must explicitly support the distinct site argument. Not all payers will accept this; verify MAC/payer policy before relying on this scenario.
Example 4 — Laparoscopic Adhesiolysis with Concurrent Enterolysis (Distinct Sites)
A 42-year-old female with post-appendectomy adhesions involving both the right adnexa and a loop of ileum adherent to the right lower quadrant abdominal wall. Laparoscopic surgery reveals: (1) right periovarian and peritubal adhesions requiring right ovariolysis/salpingolysis; (2) a separate loop of ileum adherent to the anterior abdominal wall requiring division of intestinal adhesive band. Both sites are dissected; both are documented as distinct structures requiring distinct surgical attention.
CPT: 58660 + 44180 -59 (intestinal adhesiolysis is a genuinely distinct anatomic structure — intestinal vs. adnexal; may co-report with modifier support) ICD-10-CM: N73.6 (adnexal adhesions), K66.0 (peritoneal/intestinal adhesions) Note: The intestinal adhesiolysis (44180) is at a distinctly different anatomic structure (small bowel) than the adnexal adhesiolysis (58660); co-reporting with -59 on 44180 is supported when both are separately documented. This is one of the clearer cases where co-reporting is defensible.
Example 5 — Return to OR During Global Period (Re-formation of Adhesions)
A patient had laparoscopic ovariolysis (58660) 22 days ago (within 90-day global period). She returns with recurrent right-sided pelvic pain and ultrasound shows right ovary again tethered to the pelvic sidewall. Surgeon performs laparoscopic re-adhesiolysis.
CPT: 58660 -78 (unplanned return to OR during global period for related complication — adhesion reformation) ICD-10-CM: N73.6, R10.2 (pelvic pain — right lower quadrant) Payment: -78 limits payment to the intraoperative portion only (~70% of global allowable) Note: Document that this is a related complication (re-adhesion) of the prior procedure; -78 is correct; -79 (unrelated) would be incorrect
Example 6 — Frozen Pelvis, Procedure Stopped (Reduced Service)
A 47-year-old female with known Stage IV endometriosis and prior multiple pelvic surgeries undergoes planned laparoscopic adhesiolysis. Laparoscopy reveals a completely obliterated posterior cul-de-sac with sigmoid colon fused to the posterior uterus; the right ovary is buried in a frozen pelvis against the right pelvic sidewall. After 25 minutes of attempted adhesiolysis, the surgeon determines the risks of bowel or ureteral injury are too high to safely proceed laparoscopically and elects to close.
CPT: 58660 -52 (reduced services — procedure initiated but safely abandoned before completion due to surgical risk) ICD-10-CM: N80.32 (endometriosis of posterior cul-de-sac), N80.101 (endometriosis of right ovary), N73.6 (pelvic peritoneal adhesions) Note: Document clearly in the operative note why the procedure was not completed and the safety reasoning. Some payers may reduce payment at -52 to 50% of the allowable; verify MAC policy.
Example 7 — Inpatient ICD-10-PCS Coding (Facility Coder)
Inpatient admission for chronic pelvic pain and bilateral adnexal adhesions secondary to prior PID. Laparoscopic bilateral salpingolysis and ovariolysis performed.
ICD-10-PCS:
- 0UN54ZZ (Release Right Fallopian Tube, Percutaneous Endoscopic Approach)
- 0UN64ZZ (Release Left Fallopian Tube, Percutaneous Endoscopic Approach)
- 0UN04ZZ (Release Right Ovary, Percutaneous Endoscopic Approach)
- 0UN14ZZ (Release Left Ovary, Percutaneous Endoscopic Approach)
ICD-10-CM Principal Dx: N73.6 (female pelvic peritoneal adhesions, postinfective — CC) Secondary Dx: N70.13 (chronic salpingitis and oophoritis) MS-DRG: 742 — Uterine and Adnexa Procedure for Non-Malignancy with CC/MCC (N73.6 qualifies as CC)
🔄 Comparison: 58660 vs. 58740 vs. 44180 vs. 58662
| Feature | 58660 | 58740 | 44180 | 58662 |
|---|---|---|---|---|
| Approach | Laparoscopic | Open | Laparoscopic | Laparoscopic |
| Target anatomy | Fallopian tubes / ovaries | Fallopian tubes / ovaries | Intestines/bowel | Endometriosis lesions / ovary / pelvic viscera |
| Adhesion type | Adnexal adhesions | Adnexal adhesions (open) | Intestinal adhesions | Endometriosis lesions + associated adhesions |
| Therapeutic intent | Adhesiolysis only | Adhesiolysis only | Adhesiolysis only | Fulguration or excision |
| wRVU | ~8.03 | ~8.64 | ~8.77 | ~12.47 |
| Global Period | 090 | 090 | 090 | 090 |
| Separate procedure | ✅ Yes | ✅ Yes | ✅ Yes | ❌ No |
| Can bill with 58661 | ❌ No (NCCI edit) | ❌ No (NCCI equivalent) | Possibly with -59 | Context-dependent |
| Can bill with 58662 | ❌ No (NCCI edit) | ❌ No | Possibly with -59 | N/A |
| Can co-report with each other | 58660 + 44180 with -59 if distinct sites | Generally mutual exclusion with 58660 | 44180 + 58660 with -59 | 58662 replaces 58660 |
⚠️ Common Coding Pitfalls
-
Billing 58660 alongside 58661 or 58662 without modifier support — the single most common error. 58660 is a Column 2 NCCI edit for both 58661 and 58662. When adnexal removal or endometriosis excision is the primary procedure, adhesiolysis is inherently included and 58660 must not be separately billed. ACOG explicitly states 58660 cannot be reported with 58661 “under any circumstances.”
-
Using -59 as a reflexive override for NCCI edits without documentation — modifier -59 is not a magic unbundling modifier; it requires genuine clinical documentation that the adhesiolysis was at a distinct anatomic site, was a distinct procedure, and exceeded what is ordinarily included in the primary procedure. Applying -59 without this support constitutes an NCCI violation.
-
Using -22 on 58660 instead of on the primary procedure code — when extensive adhesiolysis complicates a primary procedure, modifier -22 should be appended to the primary procedure code (e.g., 58662 -22), not to 58660. This is one of the most frequently misunderstood NCCI/CPT principles for laparoscopic GYN surgery.
-
Billing 49320 on the same day as 58660 — diagnostic laparoscopy is always included in surgical laparoscopy. 49320 cannot be billed in the same session as any surgical laparoscopy code, including 58660.
-
Using 58660 for intestinal adhesions — bowel adhesions require 44180 (laparoscopic) or 44005 (open). 58660 is exclusively for adnexal (fallopian tube and ovary) adhesions. If the same operative session involves both adnexal AND intestinal adhesiolysis at genuinely distinct sites, 58660 + 44180 -59 may be co-reportable with strong documentation.
-
Reporting 58660 as a single bilateral code vs. separate left/right — 58660 is billed as one unit per session regardless of whether one or both adnexal sides are addressed. Do NOT apply modifier -50 or report two units. The code inherently covers bilateral work.
-
Failing to document adhesion density, vascularity, and extent — “adhesions noted and lysed” is insufficient for billing compliance, audit defense, and modifier -59 or -22 support. The operative report must specifically characterize the adhesions encountered and the effort required to address them.
-
Continuing to use 58660 for incidental adhesiolysis during complex hysterectomy — adhesiolysis routinely required to complete a hysterectomy is included in the hysterectomy code. 58660 cannot be bolted onto a hysterectomy claim for the adhesiolysis required to complete the case. If truly extensive beyond ordinary, the -22 modifier on the hysterectomy code is the appropriate mechanism.
-
Not documenting chromotubation when performed — chromotubation (dye test for tubal patency) performed during 58660 in infertility cases is included and not separately billable. Documenting that it was performed, along with results (bilateral spill/unilateral spill/no spill), is important for the medical record, MIPS reporting, and infertility management, but generates no additional CPT code.
-
Missing CC diagnosis codes in the inpatient setting — N73.6 and N99.4 both qualify as CC in the MS-DRG system, shifting cases from DRG 743 → DRG 742. When these codes are appropriately documented and present, their CC credit must not be missed. CDI review of inpatient GYN surgery cases should routinely check for adhesion coding specificity.
📚 References
^[1] AMA CPT Codebook 2025 — Surgery, Female Genital System, Laparoscopic Procedures on the Oviduct/Ovary (58660-58679) ^[2] CPT Assistant Vol. 13, Issue 3 (March 2003) — Coding Lysis of Adhesions; Separate Procedure Rule for 58660 ^[3] CMS NCCI Policy Manual for Medicare Services FY2025, Chapter 11 — Surgery: Female Genital System ^[4] ACOG (American College of Obstetricians and Gynecologists) — Coding for Laparoscopic Procedures; CPT Guidance for 58661 and Bundling Rules (2024) ^[5] CMS Medicare Physician Fee Schedule 2025 (MPFS) — Addendum B, National RVU and Payment Files ^[6] AAPC Knowledge Center — Coding Lysis of Adhesions (Jan 2024); Reader Questions: Include Lysis of Adhesions in Almost All Surgeries (Aug 2021) ^[7] CMS ICD-10-PCS Official Guidelines for Coding and Reporting FY2025 — Root Operation Release (N), Female Reproductive System (Body System U) ^[8] CMS MS-DRG v42.0 Definitions Manual FY2025 — MDC 13, DRGs 742-743 (Uterine and Adnexa Procedures for Non-Malignancy) ^[9] ICD-10-CM Official Guidelines for Coding and Reporting FY2025 — Chapter 14: Diseases of the Genitourinary System; Chapter 15 (for obstetric context) ^[10] ASRM (American Society for Reproductive Medicine) — Practice Committee Opinion: Laparoscopy and Hysteroscopy in the Infertility Evaluation (2023) ^[11] BillingFreedom — CPT 58660: Laparoscopic Lysis of Tubal/Ovarian Adhesions (Nov 2025) ^[12] Pabau — CPT Code 58660: Laparoscopy with Lysis of Adhesions (Feb 2026)