2 Top Ob-Gyn FAQs Revealed: Ob Confirmatory Visit and Lysis of Adhesions

ob-gyn coding FAQs

Every day brings new challenges for coders, but there are some questions that seem to come up over and over again. Our ob-gyn experts have revealed that two questions they hear very often relate to (1) the ob global and (2) lysis of adhesions during another procedure. Get a better understanding of how to triumph over these coding troublemakers with the details below.

1. Is the Confirmatory Visit in the Ob Global?

Generally speaking, you should not include the confirmatory visit in the ob global if the patient presents only to confirm the pregnancy and you don’t start the ob record. Starting the ob record involves things like starting an ob flow sheet, doing a complete prenatal history and exam, and ob coordination where the provider (not necessarily a physician) discusses the plans for ob-related lab tests, exams, and procedure guidelines.

Example: When a patient presents to the ob-gyn to confirm the results of a home pregnancy test, you may report this outside of the ob global using the code for the lab test. An E/M code may be appropriate if documentation supports it.

Watch out: If the patient presents because another physician has already confirmed the pregnancy, then that is a different situation. The patient is there specifically for ob care and to start the ob record.

Tip: Review the CPT® guidelines that accompany the maternity codes. You’ll get helpful advice such as the number of visits included and that “Pregnancy confirmation during a problem oriented or preventive visit is not considered a part of antepartum care and should be reported using the appropriate E/M service codes.”

2. Can You Report Lysis of Adhesions Separately?

For typical cases, you should not report lysis of adhesions separately when performed as part of another gynecological surgery. Removing adhesions to access the surgical site is an expected part of a gynecological procedure and payers factor that into their time and reimbursement estimates for the surgical code.

Not surprisingly, Correct Coding Initiative (CCI) edits bundle lysis codes such as 58660 (Laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]) and 58740 (Lysis of adhesions [salpingolysis, ovariolysis]) into long lists of surgical codes.

Example: CCI bundles 58660 into 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]). The modifier indicator is 0 so you can’t use a modifier to override the edit.

Option: In cases where documentation shows the gynecologist performed significantly more work than usual, involving more effort and time, then you may consider appending modifier 22 (Increased procedural services). Expect the use of 22 to trigger a manual review that requires you to back up the request for extra reimbursement that modifier 22 signifies.

If your payer provides guidelines on when using modifier 22 is appropriate, then keep them handy to be sure you meet the requirements. If you don’t have solid guidance to follow, then here are some tips from experts based on their experience:

  • Aim for at least 25 to 50 percent more time than usual, clearly documented
  • Explain the specifics of why the procedure took longer and required more work for that particular patient, such as obesity, unusual anatomy, or scarring outside the normal range.

What About You?

What coding questions do you have a tough time finding authoritative answers for? What advice have you been given?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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