Melanie Witt, RN, CPC, MA

<huc>Q</huc> I have a patient with a BRCA mutation that places her at high risk for breast and ovarian cancer. Which diagnosis code should I use?

<huc>A</huc> If you are removing the organ, use V50.42 (prophylactic ovary removal) or V50.49 (other prophylactic organ removal) as the primary diagnosis.

If you simply want to note the mutation as a reason for further evaluation and management (E/M), try V16.3 (family history of breast cancer) or V16.41 (family history of ovarian cancer). You may use these as the primary diagnosis if there is no other reason for the encounter, or as secondary diagnoses.

Current ICD-9 rules do not permit you to code V83.89 (other genetic carrier status) for this scenario. This code is used for patients who carry a disease that can be directly passed on to their offspring, rather than for those at high risk of disease due to genetic predisposition.

ICD-9 has addressed this issue with new codes that go into effect October 1. They will be V84.01 (genetic susceptibility to malignant neoplasm of breast) and V84.02 (genetic susceptibility to malignant neoplasm of ovary). (Look for further discussion of this and other ICD-9 changes in the November issue of OBG Management).

<huc>Q</huc> I have a patient with a BRCA mutation that places her at high risk for breast and ovarian cancer. Which diagnosis code should I use?

<huc>A</huc> If you are removing the organ, use V50.42 (prophylactic ovary removal) or V50.49 (other prophylactic organ removal) as the primary diagnosis.

If you simply want to note the mutation as a reason for further evaluation and management (E/M), try V16.3 (family history of breast cancer) or V16.41 (family history of ovarian cancer). You may use these as the primary diagnosis if there is no other reason for the encounter, or as secondary diagnoses.

Current ICD-9 rules do not permit you to code V83.89 (other genetic carrier status) for this scenario. This code is used for patients who carry a disease that can be directly passed on to their offspring, rather than for those at high risk of disease due to genetic predisposition.

ICD-9 has addressed this issue with new codes that go into effect October 1. They will be V84.01 (genetic susceptibility to malignant neoplasm of breast) and V84.02 (genetic susceptibility to malignant neoplasm of ovary). (Look for further discussion of this and other ICD-9 changes in the November issue of OBG Management).

<huc>Q</huc> I have a patient with a BRCA mutation that places her at high risk for breast and ovarian cancer. Which diagnosis code should I use?

<huc>A</huc> If you are removing the organ, use V50.42 (prophylactic ovary removal) or V50.49 (other prophylactic organ removal) as the primary diagnosis.

If you simply want to note the mutation as a reason for further evaluation and management (E/M), try V16.3 (family history of breast cancer) or V16.41 (family history of ovarian cancer). You may use these as the primary diagnosis if there is no other reason for the encounter, or as secondary diagnoses.

Current ICD-9 rules do not permit you to code V83.89 (other genetic carrier status) for this scenario. This code is used for patients who carry a disease that can be directly passed on to their offspring, rather than for those at high risk of disease due to genetic predisposition.

ICD-9 has addressed this issue with new codes that go into effect October 1. They will be V84.01 (genetic susceptibility to malignant neoplasm of breast) and V84.02 (genetic susceptibility to malignant neoplasm of ovary). (Look for further discussion of this and other ICD-9 changes in the November issue of OBG Management).

Q How do you code a “saddle block” (spinal anesthesia confined to the perineum, buttocks, and inner aspect of the thighs)?

A If you, as the delivering obstetrician, performed the saddle block, add modifier -47 (anesthesia by surgeon) to the delivery code, then add 62311-51 (injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]; multiple procedure).

If the procedure was performed by an anesthesiologist during vaginal delivery, the code is 01960 (anesthesia for vaginal delivery only).

This is in line with CPT guidelines, but some payers won’t reimburse delivering physicians for the block—so be prepared to appeal, especially if no anesthesiologist was available.

Q How do you code a “saddle block” (spinal anesthesia confined to the perineum, buttocks, and inner aspect of the thighs)?

A If you, as the delivering obstetrician, performed the saddle block, add modifier -47 (anesthesia by surgeon) to the delivery code, then add 62311-51 (injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]; multiple procedure).

If the procedure was performed by an anesthesiologist during vaginal delivery, the code is 01960 (anesthesia for vaginal delivery only).

This is in line with CPT guidelines, but some payers won’t reimburse delivering physicians for the block—so be prepared to appeal, especially if no anesthesiologist was available.

Q How do you code a “saddle block” (spinal anesthesia confined to the perineum, buttocks, and inner aspect of the thighs)?

A If you, as the delivering obstetrician, performed the saddle block, add modifier -47 (anesthesia by surgeon) to the delivery code, then add 62311-51 (injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]; multiple procedure).

If the procedure was performed by an anesthesiologist during vaginal delivery, the code is 01960 (anesthesia for vaginal delivery only).

This is in line with CPT guidelines, but some payers won’t reimburse delivering physicians for the block—so be prepared to appeal, especially if no anesthesiologist was available.

Q I performed laparoscopic evaluation of a patient with pelvic pain who came to the emergency room (ER). The woman was found to have both a hemorrhagic ovarian cyst, which was cauterized, and appendicitis, for which an appendectomy was performed. What are the rules for billing these procedures together?

A Were you called for a consultation in the ER? If so, bill an outpatient consultation code with modifier -57 (decision to do surgery), as this was the visit at which surgical intervention was deemed necessary. (I assume the procedure was performed either the day of or the day after the decision.)

If no consultation was requested, use an outpatient code for the service, again with modifier -57. If the ER physician is billing for an ER service, you should not do so.

As for the surgery itself: For the cyst cautery, use 58662 (laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method); for the appendectomy, use 44970 (laparoscopy, surgical, appendectomy) with modifier -51 (multiple procedure). You can bill these together, as a different diagnosis supports each procedure and the appendectomy was not incidental.

If you assisted on the appendectomy, still bill codes 58662 and 44970, but add modifier -80 (assistant surgeon) to the latter code.

Q I performed laparoscopic evaluation of a patient with pelvic pain who came to the emergency room (ER). The woman was found to have both a hemorrhagic ovarian cyst, which was cauterized, and appendicitis, for which an appendectomy was performed. What are the rules for billing these procedures together?

A Were you called for a consultation in the ER? If so, bill an outpatient consultation code with modifier -57 (decision to do surgery), as this was the visit at which surgical intervention was deemed necessary. (I assume the procedure was performed either the day of or the day after the decision.)

If no consultation was requested, use an outpatient code for the service, again with modifier -57. If the ER physician is billing for an ER service, you should not do so.

As for the surgery itself: For the cyst cautery, use 58662 (laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method); for the appendectomy, use 44970 (laparoscopy, surgical, appendectomy) with modifier -51 (multiple procedure). You can bill these together, as a different diagnosis supports each procedure and the appendectomy was not incidental.

If you assisted on the appendectomy, still bill codes 58662 and 44970, but add modifier -80 (assistant surgeon) to the latter code.

Q I performed laparoscopic evaluation of a patient with pelvic pain who came to the emergency room (ER). The woman was found to have both a hemorrhagic ovarian cyst, which was cauterized, and appendicitis, for which an appendectomy was performed. What are the rules for billing these procedures together?

A Were you called for a consultation in the ER? If so, bill an outpatient consultation code with modifier -57 (decision to do surgery), as this was the visit at which surgical intervention was deemed necessary. (I assume the procedure was performed either the day of or the day after the decision.)

If no consultation was requested, use an outpatient code for the service, again with modifier -57. If the ER physician is billing for an ER service, you should not do so.

As for the surgery itself: For the cyst cautery, use 58662 (laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method); for the appendectomy, use 44970 (laparoscopy, surgical, appendectomy) with modifier -51 (multiple procedure). You can bill these together, as a different diagnosis supports each procedure and the appendectomy was not incidental.

If you assisted on the appendectomy, still bill codes 58662 and 44970, but add modifier -80 (assistant surgeon) to the latter code.

Q We treated an ectopic pregnancy with an injection of potassium chloride transvaginally. How is this coded?

A First, was ultrasound guidance of the needle used—and documented? If so, you can report 76942 (ultrasonic guidance for needle placement [eg, biopsy, aspiration, injection, localization device], imaging, supervision, and interpretation).

CPT does not have a code for the injection itself, and I do not advise the unlisted injection procedure code—that implies an injection in the skin or another easily accessibly location. I recommend 59899 (unlisted procedure, maternity care and delivery). You will need to submit documentation with this claim.

Q We treated an ectopic pregnancy with an injection of potassium chloride transvaginally. How is this coded?

A First, was ultrasound guidance of the needle used—and documented? If so, you can report 76942 (ultrasonic guidance for needle placement [eg, biopsy, aspiration, injection, localization device], imaging, supervision, and interpretation).

CPT does not have a code for the injection itself, and I do not advise the unlisted injection procedure code—that implies an injection in the skin or another easily accessibly location. I recommend 59899 (unlisted procedure, maternity care and delivery). You will need to submit documentation with this claim.

Q We treated an ectopic pregnancy with an injection of potassium chloride transvaginally. How is this coded?

A First, was ultrasound guidance of the needle used—and documented? If so, you can report 76942 (ultrasonic guidance for needle placement [eg, biopsy, aspiration, injection, localization device], imaging, supervision, and interpretation).

CPT does not have a code for the injection itself, and I do not advise the unlisted injection procedure code—that implies an injection in the skin or another easily accessibly location. I recommend 59899 (unlisted procedure, maternity care and delivery). You will need to submit documentation with this claim.

Q We performed a circumcision in the office. Code 54150 is listed as “Circumcision with a clamp on a newborn,” while 54152 is simply “Circumcision with a clamp.” What is the definition of newborn?

A “Newborn” refers to a liveborn infant during the first 25 days, 23 hours, and 59 minutes of life (from the 1972 American College of Obstetricians and Gynecologists book Obstetric-Gynecologic Terminology, edited by Edward C. Hughes, MD). CPT uses this same definition.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q We performed a circumcision in the office. Code 54150 is listed as “Circumcision with a clamp on a newborn,” while 54152 is simply “Circumcision with a clamp.” What is the definition of newborn?

A “Newborn” refers to a liveborn infant during the first 25 days, 23 hours, and 59 minutes of life (from the 1972 American College of Obstetricians and Gynecologists book Obstetric-Gynecologic Terminology, edited by Edward C. Hughes, MD). CPT uses this same definition.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q We performed a circumcision in the office. Code 54150 is listed as “Circumcision with a clamp on a newborn,” while 54152 is simply “Circumcision with a clamp.” What is the definition of newborn?

A “Newborn” refers to a liveborn infant during the first 25 days, 23 hours, and 59 minutes of life (from the 1972 American College of Obstetricians and Gynecologists book Obstetric-Gynecologic Terminology, edited by Edward C. Hughes, MD). CPT uses this same definition.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q I billed a nonstress test (NST) that was rejected. The note in the chart says the test was nonreactive. What should I do? Should we not have billed the NST at all, or can I just submit a diagnosis of no fetal movement?

A A nonreactive fetal NST is the finding of the exam—not the reason it was conducted. To justify performing the NST, you need to consider why it was ordered in the first place. Since this exam is done to measure fetal well-being, there are several possibilities.

To name just a few:

• complaints of decreased fetal movement (655.73)
  
• fetal size that is small or large for dates (656.53 or 656.63)
  
• previous intrauterine fetal demise (V23.49)
  
• abnormal fetal heart rate (659.73)
  
• maternal abdominal trauma (659.83, along with a diagnosis indicating the injury)
  

Whatever the reason for the test, make sure it is documented; if it is not and the records are audited, returning money to the payer would be your best-case scenario. The worst-case scenario? Accusations of fraud for billing a service not documented (meaning, to the payer, that it never happened).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q I billed a nonstress test (NST) that was rejected. The note in the chart says the test was nonreactive. What should I do? Should we not have billed the NST at all, or can I just submit a diagnosis of no fetal movement?

A A nonreactive fetal NST is the finding of the exam—not the reason it was conducted. To justify performing the NST, you need to consider why it was ordered in the first place. Since this exam is done to measure fetal well-being, there are several possibilities.

To name just a few:

• complaints of decreased fetal movement (655.73)
  
• fetal size that is small or large for dates (656.53 or 656.63)
  
• previous intrauterine fetal demise (V23.49)
  
• abnormal fetal heart rate (659.73)
  
• maternal abdominal trauma (659.83, along with a diagnosis indicating the injury)
  

Whatever the reason for the test, make sure it is documented; if it is not and the records are audited, returning money to the payer would be your best-case scenario. The worst-case scenario? Accusations of fraud for billing a service not documented (meaning, to the payer, that it never happened).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q I billed a nonstress test (NST) that was rejected. The note in the chart says the test was nonreactive. What should I do? Should we not have billed the NST at all, or can I just submit a diagnosis of no fetal movement?

A A nonreactive fetal NST is the finding of the exam—not the reason it was conducted. To justify performing the NST, you need to consider why it was ordered in the first place. Since this exam is done to measure fetal well-being, there are several possibilities.

To name just a few:

• complaints of decreased fetal movement (655.73)
  
• fetal size that is small or large for dates (656.53 or 656.63)
  
• previous intrauterine fetal demise (V23.49)
  
• abnormal fetal heart rate (659.73)
  
• maternal abdominal trauma (659.83, along with a diagnosis indicating the injury)
  

Whatever the reason for the test, make sure it is documented; if it is not and the records are audited, returning money to the payer would be your best-case scenario. The worst-case scenario? Accusations of fraud for billing a service not documented (meaning, to the payer, that it never happened).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q We performed a postcoital examination on a patient. We have always used 89300 (semen analysis; presence and/or motility of sperm including Huhner test [post coital]), but now an insurance company has denied the claim. Any suggestions?

A First you need to determine the rationale for the denial. One of the most common reasons for denial of a service is an improper diagnosis code. Inquire if the payer objected to something specific about the code you used. For instance, some insurance companies will accept a diagnosis of infertility testing (V26.29, other investigation or testing; or V26.21, fertility testing) as the reason for the postcoital test, while others require an infertility diagnosis—either female or male.

Another issue may be that the patient does not have coverage for infertility services, including testing.

If neither of these is the problem, and the payer won’t simply tell you how to bill for the exam, you might try the Health Care Financing Administration Common Procedure Coding System (HCPCS) code for this service, Q0115 (post-coital direct, qualitative examinations of vaginal or cervical mucous).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q We performed a postcoital examination on a patient. We have always used 89300 (semen analysis; presence and/or motility of sperm including Huhner test [post coital]), but now an insurance company has denied the claim. Any suggestions?

A First you need to determine the rationale for the denial. One of the most common reasons for denial of a service is an improper diagnosis code. Inquire if the payer objected to something specific about the code you used. For instance, some insurance companies will accept a diagnosis of infertility testing (V26.29, other investigation or testing; or V26.21, fertility testing) as the reason for the postcoital test, while others require an infertility diagnosis—either female or male.

Another issue may be that the patient does not have coverage for infertility services, including testing.

If neither of these is the problem, and the payer won’t simply tell you how to bill for the exam, you might try the Health Care Financing Administration Common Procedure Coding System (HCPCS) code for this service, Q0115 (post-coital direct, qualitative examinations of vaginal or cervical mucous).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q We performed a postcoital examination on a patient. We have always used 89300 (semen analysis; presence and/or motility of sperm including Huhner test [post coital]), but now an insurance company has denied the claim. Any suggestions?

A First you need to determine the rationale for the denial. One of the most common reasons for denial of a service is an improper diagnosis code. Inquire if the payer objected to something specific about the code you used. For instance, some insurance companies will accept a diagnosis of infertility testing (V26.29, other investigation or testing; or V26.21, fertility testing) as the reason for the postcoital test, while others require an infertility diagnosis—either female or male.

Another issue may be that the patient does not have coverage for infertility services, including testing.

If neither of these is the problem, and the payer won’t simply tell you how to bill for the exam, you might try the Health Care Financing Administration Common Procedure Coding System (HCPCS) code for this service, Q0115 (post-coital direct, qualitative examinations of vaginal or cervical mucous).

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q My physician removed a patient’s ovaries and also performed a dilation and curettage. We coded these procedures as 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) and 58120-51 (Dilation and curettage, diagnostic and/or therapeutic [nonobstetrical]; multiple procedure), but received extremely low reimbursement.

The operative report stated extensive work was involved. An 8-cm ovarian cyst was excised, and some cystic fluid aspirated. Should we appeal? Also, should we have added modifier -22 (unusual procedural services) to 58661?

A First, keep in mind that payers always reduce the allowable on the second procedure performed, since they are paying for only the intraservice work, not the procedure’s entire global package.

Next: Code 58661 does not allow you to bill additionally for ovarian cyst removal or cystic fluid aspiration, because the physician also removed the ovary. However, there is 1 scenario in which additional reimbursement is possible.

An oophorectomy is by definition the removal of 1 ovary. For CPT codes in which oophorectomy is an integral part of the procedure (eg, total abdominal hysterectomy/bilateral salpingo-oophorectomy, open oophorectomy, open salpingo-oophorectomy) the language indicates whether they are used to report a partial or total unilateral or bilateral removal. Code 58661, however, only indicates “partial or total oophorectomy”—leading to the belief that it applies to only 1 side, not both.

If a physician removes the ovary on 1 side, but removes an ovarian cyst on the other, and if the payer agrees with this interpretation of the code, you might be able to bill both 58661 and 58662 (which covers both removal and aspiration of the ovarian cyst), placing the modifiers -RT (right side) and -LT (left side) as appropriate. Still, many payers—including Medicare—do not agree with this interpretation and will not reimburse in this manner.

Your question, however, indicates that both ovaries were removed. Thus, additional reimbursement is unlikely.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q My physician removed a patient’s ovaries and also performed a dilation and curettage. We coded these procedures as 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) and 58120-51 (Dilation and curettage, diagnostic and/or therapeutic [nonobstetrical]; multiple procedure), but received extremely low reimbursement.

The operative report stated extensive work was involved. An 8-cm ovarian cyst was excised, and some cystic fluid aspirated. Should we appeal? Also, should we have added modifier -22 (unusual procedural services) to 58661?

A First, keep in mind that payers always reduce the allowable on the second procedure performed, since they are paying for only the intraservice work, not the procedure’s entire global package.

Next: Code 58661 does not allow you to bill additionally for ovarian cyst removal or cystic fluid aspiration, because the physician also removed the ovary. However, there is 1 scenario in which additional reimbursement is possible.

An oophorectomy is by definition the removal of 1 ovary. For CPT codes in which oophorectomy is an integral part of the procedure (eg, total abdominal hysterectomy/bilateral salpingo-oophorectomy, open oophorectomy, open salpingo-oophorectomy) the language indicates whether they are used to report a partial or total unilateral or bilateral removal. Code 58661, however, only indicates “partial or total oophorectomy”—leading to the belief that it applies to only 1 side, not both.

If a physician removes the ovary on 1 side, but removes an ovarian cyst on the other, and if the payer agrees with this interpretation of the code, you might be able to bill both 58661 and 58662 (which covers both removal and aspiration of the ovarian cyst), placing the modifiers -RT (right side) and -LT (left side) as appropriate. Still, many payers—including Medicare—do not agree with this interpretation and will not reimburse in this manner.

Your question, however, indicates that both ovaries were removed. Thus, additional reimbursement is unlikely.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q My physician removed a patient’s ovaries and also performed a dilation and curettage. We coded these procedures as 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) and 58120-51 (Dilation and curettage, diagnostic and/or therapeutic [nonobstetrical]; multiple procedure), but received extremely low reimbursement.

The operative report stated extensive work was involved. An 8-cm ovarian cyst was excised, and some cystic fluid aspirated. Should we appeal? Also, should we have added modifier -22 (unusual procedural services) to 58661?

A First, keep in mind that payers always reduce the allowable on the second procedure performed, since they are paying for only the intraservice work, not the procedure’s entire global package.

Next: Code 58661 does not allow you to bill additionally for ovarian cyst removal or cystic fluid aspiration, because the physician also removed the ovary. However, there is 1 scenario in which additional reimbursement is possible.

An oophorectomy is by definition the removal of 1 ovary. For CPT codes in which oophorectomy is an integral part of the procedure (eg, total abdominal hysterectomy/bilateral salpingo-oophorectomy, open oophorectomy, open salpingo-oophorectomy) the language indicates whether they are used to report a partial or total unilateral or bilateral removal. Code 58661, however, only indicates “partial or total oophorectomy”—leading to the belief that it applies to only 1 side, not both.

If a physician removes the ovary on 1 side, but removes an ovarian cyst on the other, and if the payer agrees with this interpretation of the code, you might be able to bill both 58661 and 58662 (which covers both removal and aspiration of the ovarian cyst), placing the modifiers -RT (right side) and -LT (left side) as appropriate. Still, many payers—including Medicare—do not agree with this interpretation and will not reimburse in this manner.

Your question, however, indicates that both ovaries were removed. Thus, additional reimbursement is unlikely.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Can you enlighten me on therapeutic hydrodistention of the bladder: What is this for? What code would I use? A diagnostic cystoscopy was also performed.

A Cystoscopy with hydrodistention, usually done as an outpatient procedure under regional or general anesthesia, is used to diagnose and sometimes treat interstitial cystitis.

During cystoscopy, the inside of the bladder is examined. Then the bladder is filled to a high pressure with fluid (hydrodistended). This causes the bladder wall to stretch, allowing the physician to inspect for changes typical of interstitial cystitis. Hydrodistention may reduce pain and discomfort in some interstitial cystitis patients, and thus may be therapeutic as well as diagnostic.

For this procedure, code either 52260 (Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction [spinal] anesthesia) or 52265 (…with local anesthesia). Be sure to verify the anesthesia type before billing for this service.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Can you enlighten me on therapeutic hydrodistention of the bladder: What is this for? What code would I use? A diagnostic cystoscopy was also performed.

A Cystoscopy with hydrodistention, usually done as an outpatient procedure under regional or general anesthesia, is used to diagnose and sometimes treat interstitial cystitis.

During cystoscopy, the inside of the bladder is examined. Then the bladder is filled to a high pressure with fluid (hydrodistended). This causes the bladder wall to stretch, allowing the physician to inspect for changes typical of interstitial cystitis. Hydrodistention may reduce pain and discomfort in some interstitial cystitis patients, and thus may be therapeutic as well as diagnostic.

For this procedure, code either 52260 (Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction [spinal] anesthesia) or 52265 (…with local anesthesia). Be sure to verify the anesthesia type before billing for this service.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Can you enlighten me on therapeutic hydrodistention of the bladder: What is this for? What code would I use? A diagnostic cystoscopy was also performed.

A Cystoscopy with hydrodistention, usually done as an outpatient procedure under regional or general anesthesia, is used to diagnose and sometimes treat interstitial cystitis.

During cystoscopy, the inside of the bladder is examined. Then the bladder is filled to a high pressure with fluid (hydrodistended). This causes the bladder wall to stretch, allowing the physician to inspect for changes typical of interstitial cystitis. Hydrodistention may reduce pain and discomfort in some interstitial cystitis patients, and thus may be therapeutic as well as diagnostic.

For this procedure, code either 52260 (Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction [spinal] anesthesia) or 52265 (…with local anesthesia). Be sure to verify the anesthesia type before billing for this service.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q What is the diagnostic code for breast asymmetry?

A This is a common complaint, especially for patients in whom one breast is a cup size or more smaller than the other. But breast asymmetry isn’t always due to a disease process or congenital deformity—in most people one side of the body is smaller than the other.

The congenital cause is called Poland’s Syndrome. With this condition not only is one breast underdeveloped, but the same-side hand also exhibits anomalies. Clearly, the physician would need to confirm this diagnosis. Code 757.6 (specified anomalies of breast) would work for this syndrome, as well as for cases with documented hypoplasia of the breast.

Another cause of asymmetry might be infection, trauma, or surgery near the developing breast when the patient was a child. For instance, if the patient had a history of a wound and the current breast asymmetry is considered a “late effect” of that wound, you might code 906.0 (late effect of open wound of head, neck, and trunk).

When the cause of the complaint of asymmetry is unknown, consider using 611.79 (other signs and symptoms in breast).

Some women are very sensitive to differences in breast size and want to correct the appearance with a prosthetic bra or surgery. Just make sure that the documentation supports any diagnostic code you use and clearly indicates whether the treatment is cosmetic.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q What is the diagnostic code for breast asymmetry?

A This is a common complaint, especially for patients in whom one breast is a cup size or more smaller than the other. But breast asymmetry isn’t always due to a disease process or congenital deformity—in most people one side of the body is smaller than the other.

The congenital cause is called Poland’s Syndrome. With this condition not only is one breast underdeveloped, but the same-side hand also exhibits anomalies. Clearly, the physician would need to confirm this diagnosis. Code 757.6 (specified anomalies of breast) would work for this syndrome, as well as for cases with documented hypoplasia of the breast.

Another cause of asymmetry might be infection, trauma, or surgery near the developing breast when the patient was a child. For instance, if the patient had a history of a wound and the current breast asymmetry is considered a “late effect” of that wound, you might code 906.0 (late effect of open wound of head, neck, and trunk).

When the cause of the complaint of asymmetry is unknown, consider using 611.79 (other signs and symptoms in breast).

Some women are very sensitive to differences in breast size and want to correct the appearance with a prosthetic bra or surgery. Just make sure that the documentation supports any diagnostic code you use and clearly indicates whether the treatment is cosmetic.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q What is the diagnostic code for breast asymmetry?

A This is a common complaint, especially for patients in whom one breast is a cup size or more smaller than the other. But breast asymmetry isn’t always due to a disease process or congenital deformity—in most people one side of the body is smaller than the other.

The congenital cause is called Poland’s Syndrome. With this condition not only is one breast underdeveloped, but the same-side hand also exhibits anomalies. Clearly, the physician would need to confirm this diagnosis. Code 757.6 (specified anomalies of breast) would work for this syndrome, as well as for cases with documented hypoplasia of the breast.

Another cause of asymmetry might be infection, trauma, or surgery near the developing breast when the patient was a child. For instance, if the patient had a history of a wound and the current breast asymmetry is considered a “late effect” of that wound, you might code 906.0 (late effect of open wound of head, neck, and trunk).

When the cause of the complaint of asymmetry is unknown, consider using 611.79 (other signs and symptoms in breast).

Some women are very sensitive to differences in breast size and want to correct the appearance with a prosthetic bra or surgery. Just make sure that the documentation supports any diagnostic code you use and clearly indicates whether the treatment is cosmetic.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.