In modern abdominal and pelvic surgeries, lysis of adhesions is a crucial procedure used to remove or separate scar tissue that forms between internal organs and tissues. These adhesions often develop after prior surgeries, infections, or inflammation, leading to pain, bowel obstruction, or infertility.
Accurate understanding and usage of the lysis of adhesions CPT code are vital for correct medical documentation, billing, and insurance reimbursement. This detailed guide explains the CPT code for lysis of adhesions, its indications, procedure, coding nuances, and how Meister Surgical provides precision instruments that help surgeons perform the procedure effectively and safely.
What Is Lysis of Adhesions?
Lysis of adhesions is a surgical procedure in which fibrous scar tissue (adhesions) connecting organs or tissues abnormally is cut, removed, or separated.
Adhesions may form anywhere in the body but are most commonly found in the:
- Abdominal cavity (between intestines, omentum, or abdominal wall)
- Pelvic cavity (around ovaries, uterus, or fallopian tubes)
The goal of this procedure is to restore normal organ mobility, relieve pain, and prevent obstructions caused by these abnormal attachments.
Common Causes of Adhesion Formation
Adhesions usually develop as a natural healing response following tissue injury. However, excessive scar tissue can create abnormal bands that restrict movement or cause pain.
Major causes include:
- Prior abdominal or pelvic surgeries (e.g., appendectomy, cesarean section)
- Infections such as pelvic inflammatory disease (PID)
- Endometriosis
- Radiation therapy
- Abdominal trauma or inflammation
- Post-surgical healing response
Over time, these adhesions can lead to complications such as bowel obstruction, chronic abdominal pain, or infertility in women.
When Is Lysis of Adhesions Performed?
The procedure is recommended when adhesions interfere with normal organ function or cause persistent pain.
Indications include:
- Intestinal obstruction due to adhesions
- Chronic abdominal or pelvic pain unresponsive to medication
- Infertility due to adhesions involving reproductive organs
- Recurrent bowel obstruction symptoms
- Restricted organ movement affecting nearby structures
Depending on the extent of adhesions and patient condition, the surgeon may perform laparoscopic or open lysis of adhesions.
Lysis of Adhesions CPT Codes Explained
The correct CPT code depends on the location, extent, and method of the procedure.
Below are the most commonly used lysis of adhesions CPT codes:
| CPT Code | Description | Approach |
|---|---|---|
| 44005 | Lysis of adhesions (enterolysis), open, for intestine | Open abdominal surgery |
| 44180 | Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) | Laparoscopic |
| 58660 | Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) | Laparoscopic, gynecologic |
| 58740 | Lysis of adhesions (salpingolysis, ovariolysis), open | Open, gynecologic |
| 49329 | Unlisted laparoscopy procedure, abdomen, peritoneum, and omentum | When no specific code applies |
Each code is specific to the area and method of surgery — using the correct one is essential for accurate billing and avoiding insurance claim denials.
Detailed Breakdown of Each CPT Code
1. CPT 44005 – Open Enterolysis
This code is used for open abdominal surgery where intestinal adhesions are manually removed.
It’s often performed when severe adhesions cause bowel obstruction or when laparoscopy isn’t feasible.
Documentation Requirements:
- Specify that adhesions were causing obstruction or pain.
- Mention the anatomical sites involved.
- Include the extent and technique of adhesiolysis.
2. CPT 44180 – Laparoscopic Enterolysis
Used for laparoscopic lysis of intestinal adhesions, CPT 44180 applies when the surgeon uses minimally invasive techniques.
Advantages:
- Smaller incisions
- Less postoperative pain
- Quicker recovery time
- Reduced infection risk
Note:
If a laparoscopic procedure starts as exploratory (e.g., CPT 49320) and then transitions into adhesiolysis, use CPT 44180 for the therapeutic procedure and not the exploratory code.
3. CPT 58660 – Laparoscopic Gynecologic Adhesiolysis
This code is applied when adhesions are removed from reproductive organs such as ovaries or fallopian tubes using laparoscopy.
Common indications:
- Infertility due to tubal adhesions
- Endometriosis-related pelvic adhesions
- Chronic pelvic pain
4. CPT 58740 – Open Gynecologic Adhesiolysis
Used for open abdominal procedures that involve the removal of adhesions from the uterus, fallopian tubes, or ovaries.
While laparoscopy is preferred, open surgery may be necessary for severe or extensive adhesions.
5. CPT 49329 – Unlisted Laparoscopy Procedure
If adhesiolysis is performed in areas not specifically covered by other CPT codes (e.g., retroperitoneum), CPT 49329 may be used.
Always include detailed operative notes and justification when using this unlisted code.
Documentation and Billing Tips
Proper coding and documentation are key to successful claims processing.
Tips for accurate billing:
- Document whether the procedure was open or laparoscopic.
- Describe the extent and severity of adhesions (e.g., mild, moderate, dense).
- Specify whether adhesiolysis was incidental or a primary procedure.
- Use appropriate modifiers if multiple procedures were performed:
- Modifier 51 for multiple procedures.
- Modifier 59 for distinct procedural service.
- Never report exploratory laparoscopy (CPT 49320) with CPT 44180 on the same site in the same session.
Surgical Procedure Overview
The lysis of adhesions can be performed either laparoscopically or through open surgery.
Laparoscopic Procedure Steps:
- The patient is placed under general anesthesia.
- Small incisions are made in the abdomen.
- A laparoscope (a camera-equipped instrument) is inserted.
- CO₂ gas inflates the abdomen for better visualization.
- Adhesions are carefully dissected and removed using precision instruments.
- The incisions are closed with sutures.
Open Procedure Steps:
- A larger incision is made to access the abdominal cavity.
- The surgeon manually locates and cuts adhesions using scissors, clamps, and forceps.
- The area is irrigated and inspected for bleeding.
- The incision is sutured in layers.
Clinical Importance of Lysis of Adhesions
The procedure significantly improves quality of life by:
- Relieving chronic pain caused by organ restriction.
- Restoring fertility in women with pelvic adhesions.
- Preventing recurrent bowel obstructions.
- Enhancing mobility of abdominal organs for future surgeries.
However, surgeons must perform the procedure carefully, as new adhesions may form postoperatively if tissue trauma occurs again.
Laparoscopic vs. Open Lysis of Adhesions
| Feature | Laparoscopic | Open Surgery |
|---|---|---|
| Incision Size | Small | Large |
| Recovery Time | 1–2 weeks | 4–6 weeks |
| Infection Risk | Low | Moderate |
| Hospital Stay | Short | Longer |
| Visualization | Enhanced (camera magnification) | Direct manual view |
| Preferred For | Mild to moderate adhesions | Dense or extensive adhesions |
Instruments Used in Lysis of Adhesions
Precise and sterile instruments are crucial for safe adhesiolysis.
Essential tools include:
- Laparoscopic scissors and dissectors
- Graspers and forceps
- Electrocautery instruments
- Trocars and cannulas
- Suction and irrigation systems
- Retractors and clamps
At Meister Surgical, we manufacture a complete range of laparoscopic and open surgery instruments specifically designed for procedures like lysis of adhesions.
Our instruments are:
- Crafted from high-grade stainless steel
- CE and ISO certified
- Ergonomically designed for surgeon comfort
- Precisely calibrated for delicate tissue dissection
For product inquiries or custom surgical sets, contact info@meistersurgical.com.
Outbound Reference
For official CPT coding details and updates, refer to the American Medical Association (AMA) CPT Code Directory for the latest procedural coding guidelines.
Conclusion
The lysis of adhesions CPT code plays a vital role in ensuring correct documentation and billing for one of the most common yet complex abdominal and pelvic procedures. Understanding which code applies—44005, 44180, 58660, or 58740—depends on the surgical site and approach used.
Performing lysis of adhesions requires not only surgical skill but also precision-engineered instruments to ensure safety and accuracy. With Meister Surgical, you can rely on world-class tools built to enhance surgical outcomes and maintain the highest medical standards.
Visit Meister Surgical to explore our complete range of laparoscopic and open surgical instruments, or reach out via info@meistersurgical.com for more information.