New TAH-BSO code pays less for less work

Q The new code for total abdominal hysterectomy–bilateral salpingooophorectomy (TAH-BSO) with malignancy, 58956, pays less than some of the other codes for malignancy or hysterectomy. Why?

A If you analyze the procedures included in code 58956 (BSO with total omentectomy, total abdominal hysterectomy for malignancy) and compare those with other codes for malignancy with hysterectomy, you will find 5 codes that have a higher RVU: 58210, 58951, 58952, 58953, and 58954. This is because the procedures associated with the new code involve less work than these other procedures.

For instance, code 58951 includes pelvic and limited paraaortic lymphadenectomy in addition to hysterectomy, BSO, and omentectomy. The code for the radical hysterectomy, 58210, also has a higher RVU than 58956, but again that is because the procedure requires more physician work. With 58956, only a total hysterectomy is performed, but 58210 is for a radical hysterectomy; that is, in addition to the uterus and cervix, the parametrium, uterosacral ligaments, and the upper part of the vagina are removed. In the case of codes 58952 through 58954, these procedures also involve radical dissection for debulking, which involves removal or destruction of intraabdominal or retroperitoneal tumors in addition to all the other work.

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 The new code for total abdominal hysterectomy–bilateral salpingooophorectomy (TAH-BSO) with malignancy, 58956, pays less than some of the other codes for malignancy or hysterectomy. Why?

A If you analyze the procedures included in code 58956 (BSO with total omentectomy, total abdominal hysterectomy for malignancy) and compare those with other codes for malignancy with hysterectomy, you will find 5 codes that have a higher RVU: 58210, 58951, 58952, 58953, and 58954. This is because the procedures associated with the new code involve less work than these other procedures.

For instance, code 58951 includes pelvic and limited paraaortic lymphadenectomy in addition to hysterectomy, BSO, and omentectomy. The code for the radical hysterectomy, 58210, also has a higher RVU than 58956, but again that is because the procedure requires more physician work. With 58956, only a total hysterectomy is performed, but 58210 is for a radical hysterectomy; that is, in addition to the uterus and cervix, the parametrium, uterosacral ligaments, and the upper part of the vagina are removed. In the case of codes 58952 through 58954, these procedures also involve radical dissection for debulking, which involves removal or destruction of intraabdominal or retroperitoneal tumors in addition to all the other work.

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 The new code for total abdominal hysterectomy–bilateral salpingooophorectomy (TAH-BSO) with malignancy, 58956, pays less than some of the other codes for malignancy or hysterectomy. Why?

A If you analyze the procedures included in code 58956 (BSO with total omentectomy, total abdominal hysterectomy for malignancy) and compare those with other codes for malignancy with hysterectomy, you will find 5 codes that have a higher RVU: 58210, 58951, 58952, 58953, and 58954. This is because the procedures associated with the new code involve less work than these other procedures.

For instance, code 58951 includes pelvic and limited paraaortic lymphadenectomy in addition to hysterectomy, BSO, and omentectomy. The code for the radical hysterectomy, 58210, also has a higher RVU than 58956, but again that is because the procedure requires more physician work. With 58956, only a total hysterectomy is performed, but 58210 is for a radical hysterectomy; that is, in addition to the uterus and cervix, the parametrium, uterosacral ligaments, and the upper part of the vagina are removed. In the case of codes 58952 through 58954, these procedures also involve radical dissection for debulking, which involves removal or destruction of intraabdominal or retroperitoneal tumors in addition to all the other work.

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.