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Low payment for cystectomy with oophorectomy
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?
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.
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?
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.
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?
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.
Hydrodistention, cystoscopy: Why and what code?
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.
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.
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.
Asymmetrical breasts: Common but cosmetic
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.
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.
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.
How to code a new incontinence procedure
Since this procedure does not use materials such as surgical mesh, cadaver tissue, bone screws, or staples, you cannot bill code 57288. Likewise, this is not a paravaginal defect repair, as suggested by 57284.
If you want to pick a code with a more appropriate description, try 51845 (abdomino-vaginal vesical neck suspension, with or without endoscopic control [eg, Stamey, Raz, modified Pereyra]) or 51990 (laparoscopy, surgical; urethral suspension for stress incontinence)—but if the payer considers this procedure investigational, you may run into trouble later should you be audited.
The safest course would be to bill unlisted code 53899 (unlisted procedure, urinary system) and send in documentation that supports the procedure as a viable standard of care for the presenting problem.
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.
Since this procedure does not use materials such as surgical mesh, cadaver tissue, bone screws, or staples, you cannot bill code 57288. Likewise, this is not a paravaginal defect repair, as suggested by 57284.
If you want to pick a code with a more appropriate description, try 51845 (abdomino-vaginal vesical neck suspension, with or without endoscopic control [eg, Stamey, Raz, modified Pereyra]) or 51990 (laparoscopy, surgical; urethral suspension for stress incontinence)—but if the payer considers this procedure investigational, you may run into trouble later should you be audited.
The safest course would be to bill unlisted code 53899 (unlisted procedure, urinary system) and send in documentation that supports the procedure as a viable standard of care for the presenting problem.
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.
Since this procedure does not use materials such as surgical mesh, cadaver tissue, bone screws, or staples, you cannot bill code 57288. Likewise, this is not a paravaginal defect repair, as suggested by 57284.
If you want to pick a code with a more appropriate description, try 51845 (abdomino-vaginal vesical neck suspension, with or without endoscopic control [eg, Stamey, Raz, modified Pereyra]) or 51990 (laparoscopy, surgical; urethral suspension for stress incontinence)—but if the payer considers this procedure investigational, you may run into trouble later should you be audited.
The safest course would be to bill unlisted code 53899 (unlisted procedure, urinary system) and send in documentation that supports the procedure as a viable standard of care for the presenting problem.
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.
5-month follow-up after cancer resection
Second, I presume that the surgeon does not consider the patient cancer-free. ICD-9 states that a diagnosis of “personal history of cancer” is made only after all treatment is completed. At 5 months postsurgery, I am not sure this would be true—at least until 2 or 3 normal Pap interpretations assure the physician that the original cancer is gone.
And third, I assume the patient is not a Medicare beneficiary, which further changes the coding rules.
I would code the visit’s primary diagnosis as endometrial cancer, with a secondary diagnosis of V67.01 (follow-up vaginal Pap smear). This code was created to report a vaginal Pap smear after a hysterectomy for malignancy.
Once you have obtained 2 or more negative Pap results, you can use V67.01 as the primary diagnosis and V10.42 as the secondary diagnosis for each Pap smear encounter. This will take care of the ICD-9 rule stating you cannot report a “personal history” V code as the primary diagnosis.
If the patient still has her cervix, use the code for endometrial cancer for the visit’s diagnostic Pap. Once you have 2 or 3 normal Pap results, you can revert to V76.2 for the Pap interpretation. You would use this as the primary code and V10.42 for the secondary diagnosis. Note some payers will allow you to bill for a handling fee using 99000.
Second, I presume that the surgeon does not consider the patient cancer-free. ICD-9 states that a diagnosis of “personal history of cancer” is made only after all treatment is completed. At 5 months postsurgery, I am not sure this would be true—at least until 2 or 3 normal Pap interpretations assure the physician that the original cancer is gone.
And third, I assume the patient is not a Medicare beneficiary, which further changes the coding rules.
I would code the visit’s primary diagnosis as endometrial cancer, with a secondary diagnosis of V67.01 (follow-up vaginal Pap smear). This code was created to report a vaginal Pap smear after a hysterectomy for malignancy.
Once you have obtained 2 or more negative Pap results, you can use V67.01 as the primary diagnosis and V10.42 as the secondary diagnosis for each Pap smear encounter. This will take care of the ICD-9 rule stating you cannot report a “personal history” V code as the primary diagnosis.
If the patient still has her cervix, use the code for endometrial cancer for the visit’s diagnostic Pap. Once you have 2 or 3 normal Pap results, you can revert to V76.2 for the Pap interpretation. You would use this as the primary code and V10.42 for the secondary diagnosis. Note some payers will allow you to bill for a handling fee using 99000.
Second, I presume that the surgeon does not consider the patient cancer-free. ICD-9 states that a diagnosis of “personal history of cancer” is made only after all treatment is completed. At 5 months postsurgery, I am not sure this would be true—at least until 2 or 3 normal Pap interpretations assure the physician that the original cancer is gone.
And third, I assume the patient is not a Medicare beneficiary, which further changes the coding rules.
I would code the visit’s primary diagnosis as endometrial cancer, with a secondary diagnosis of V67.01 (follow-up vaginal Pap smear). This code was created to report a vaginal Pap smear after a hysterectomy for malignancy.
Once you have obtained 2 or more negative Pap results, you can use V67.01 as the primary diagnosis and V10.42 as the secondary diagnosis for each Pap smear encounter. This will take care of the ICD-9 rule stating you cannot report a “personal history” V code as the primary diagnosis.
If the patient still has her cervix, use the code for endometrial cancer for the visit’s diagnostic Pap. Once you have 2 or 3 normal Pap results, you can revert to V76.2 for the Pap interpretation. You would use this as the primary code and V10.42 for the secondary diagnosis. Note some payers will allow you to bill for a handling fee using 99000.
Screening after abnormal Pap: ‘Problem, not preventive’
Payers do not recognize Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) with the appropriate evaluation/management (E/M) code and with 795.0X (abnormal Pap smear) as the diagnosis. Because a Pap is not a routine procedure with our E/M visits, we typically bill out the Q0091 code.
A follow-up abnormal Pap is a problem—not a preventive—E/M service. Collection is part of the exam and not coded separately.
One insurance company told me I should use laboratory codes 88142-88150. Any advice?
It was developed in a time when Medicare did not cover annual preventive gynecologic examinations, but did pay laboratories for interpreting cervical smears collected at these preventive visits. Medicare wanted to give physicians some reimbursement for their time spent collecting the specimen. In 1998 Medicare began covering pelvic and breast exams, but continued to pay for specimen collection for screening Pap smears.
A follow-up abnormal Pap, however, is billed as a problem—not a preventive—E/M service. In this case, Medicare agrees with ACOG that the collection is part of the exam and not coded separately.
Many private payers have also adopted this view—even those that formerly reimbursed a small fee for collection with code 99000 (handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory).
Under no circumstance should a laboratory code be billed for collecting the specimen.
Payers do not recognize Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) with the appropriate evaluation/management (E/M) code and with 795.0X (abnormal Pap smear) as the diagnosis. Because a Pap is not a routine procedure with our E/M visits, we typically bill out the Q0091 code.
A follow-up abnormal Pap is a problem—not a preventive—E/M service. Collection is part of the exam and not coded separately.
One insurance company told me I should use laboratory codes 88142-88150. Any advice?
It was developed in a time when Medicare did not cover annual preventive gynecologic examinations, but did pay laboratories for interpreting cervical smears collected at these preventive visits. Medicare wanted to give physicians some reimbursement for their time spent collecting the specimen. In 1998 Medicare began covering pelvic and breast exams, but continued to pay for specimen collection for screening Pap smears.
A follow-up abnormal Pap, however, is billed as a problem—not a preventive—E/M service. In this case, Medicare agrees with ACOG that the collection is part of the exam and not coded separately.
Many private payers have also adopted this view—even those that formerly reimbursed a small fee for collection with code 99000 (handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory).
Under no circumstance should a laboratory code be billed for collecting the specimen.
Payers do not recognize Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) with the appropriate evaluation/management (E/M) code and with 795.0X (abnormal Pap smear) as the diagnosis. Because a Pap is not a routine procedure with our E/M visits, we typically bill out the Q0091 code.
A follow-up abnormal Pap is a problem—not a preventive—E/M service. Collection is part of the exam and not coded separately.
One insurance company told me I should use laboratory codes 88142-88150. Any advice?
It was developed in a time when Medicare did not cover annual preventive gynecologic examinations, but did pay laboratories for interpreting cervical smears collected at these preventive visits. Medicare wanted to give physicians some reimbursement for their time spent collecting the specimen. In 1998 Medicare began covering pelvic and breast exams, but continued to pay for specimen collection for screening Pap smears.
A follow-up abnormal Pap, however, is billed as a problem—not a preventive—E/M service. In this case, Medicare agrees with ACOG that the collection is part of the exam and not coded separately.
Many private payers have also adopted this view—even those that formerly reimbursed a small fee for collection with code 99000 (handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory).
Under no circumstance should a laboratory code be billed for collecting the specimen.
Vaginal bleeding after the postpartum period
If there is a finding of retained products of conception, use 667.04 (retained placenta without hemorrhage) or 667.14 (retained portions of placenta or membranes, without hemorrhage) along with 677.
If the report shows no products but the physician believes the bleeding is related to pregnancy, your choices include:
- 665.34 for a laceration on the cervix,
- 665.74 for a hematoma of the vagina,
- 665.84 for some “other” specified obstetrical trauma, or
- 665.94 for an unspecified trauma.
If none of these fit or if the bleeding turns out to be unrelated to the pregnancy, bill 626.8 from the Gyn chapter for other dysfunctional bleeding.
If there is a finding of retained products of conception, use 667.04 (retained placenta without hemorrhage) or 667.14 (retained portions of placenta or membranes, without hemorrhage) along with 677.
If the report shows no products but the physician believes the bleeding is related to pregnancy, your choices include:
- 665.34 for a laceration on the cervix,
- 665.74 for a hematoma of the vagina,
- 665.84 for some “other” specified obstetrical trauma, or
- 665.94 for an unspecified trauma.
If none of these fit or if the bleeding turns out to be unrelated to the pregnancy, bill 626.8 from the Gyn chapter for other dysfunctional bleeding.
If there is a finding of retained products of conception, use 667.04 (retained placenta without hemorrhage) or 667.14 (retained portions of placenta or membranes, without hemorrhage) along with 677.
If the report shows no products but the physician believes the bleeding is related to pregnancy, your choices include:
- 665.34 for a laceration on the cervix,
- 665.74 for a hematoma of the vagina,
- 665.84 for some “other” specified obstetrical trauma, or
- 665.94 for an unspecified trauma.
If none of these fit or if the bleeding turns out to be unrelated to the pregnancy, bill 626.8 from the Gyn chapter for other dysfunctional bleeding.
Does morcellation change hysterectomy coding?
Currently, no code exists for laparoscopic supracervical hysterectomy. Your proposed choice, 58550-52 (laparoscopy surgical; with vaginal hysterectomy for uterus 250 grams or less; reduced service), is sometimes used, but payers just as frequently accept unlisted code 58578 (unlisted laparoscopy procedure, uterus). The latter option, with documentation, sometimes results in prompter and fairer reimbursement over the -52 modifier option. The reason: The procedure is more completely described via the submitted documentation, and payers are less likely to reduce their allowable, even though the cervix was left in place.
When morcellation of the uterus is performed, however, the situation changes: This technique is performed to shred and extract a very large uterus, and CPT has a code (58553) for laparoscopic vaginal hysterectomy for a uterus weighing more than 250 g. Thus, your options would be to bill either 58553-52 or the unlisted code 58578.
Currently, no code exists for laparoscopic supracervical hysterectomy. Your proposed choice, 58550-52 (laparoscopy surgical; with vaginal hysterectomy for uterus 250 grams or less; reduced service), is sometimes used, but payers just as frequently accept unlisted code 58578 (unlisted laparoscopy procedure, uterus). The latter option, with documentation, sometimes results in prompter and fairer reimbursement over the -52 modifier option. The reason: The procedure is more completely described via the submitted documentation, and payers are less likely to reduce their allowable, even though the cervix was left in place.
When morcellation of the uterus is performed, however, the situation changes: This technique is performed to shred and extract a very large uterus, and CPT has a code (58553) for laparoscopic vaginal hysterectomy for a uterus weighing more than 250 g. Thus, your options would be to bill either 58553-52 or the unlisted code 58578.
Currently, no code exists for laparoscopic supracervical hysterectomy. Your proposed choice, 58550-52 (laparoscopy surgical; with vaginal hysterectomy for uterus 250 grams or less; reduced service), is sometimes used, but payers just as frequently accept unlisted code 58578 (unlisted laparoscopy procedure, uterus). The latter option, with documentation, sometimes results in prompter and fairer reimbursement over the -52 modifier option. The reason: The procedure is more completely described via the submitted documentation, and payers are less likely to reduce their allowable, even though the cervix was left in place.
When morcellation of the uterus is performed, however, the situation changes: This technique is performed to shred and extract a very large uterus, and CPT has a code (58553) for laparoscopic vaginal hysterectomy for a uterus weighing more than 250 g. Thus, your options would be to bill either 58553-52 or the unlisted code 58578.
Total vaginal hysterectomy as prophylaxis
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.
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.
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.
The challenge of coding vaginal cuff repair
Most coders suggest using either an unlisted code or the repair codes from CPT’s integumentary section. The circumstance of the repair will determine which course of action is best:
- You cannot use the codes for a simple (12001-12007) or intermediate repair (12041-12047), because they specify external genitalia.
- If the repair is due to the original sutures coming loose, you can try 12020 (treatment of superficial wound dehiscence; simple closure).
- Codes 13131–13133 (repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;…) specify only “genitalia,” which includes internal structures of the vaginal canal. However, you may use these codes only if the patient’s record lists the size of the repair and the repair meets the definition of “complex” as outlined in the CPT guideline.
- If the repair is necessary because of an injury, use 57200 (colporrhaphy, suture of injury of vagina [nonobstetrical]).
- If none of these fit, you will be stuck with 58999 (unlisted procedure, female genital system [nonobstetrical]).
- Remember to add modifier -78 (return to the operating room for a related procedure during the postoperative period) if the repair is related to previous surgery and you are in the global period.
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.
Most coders suggest using either an unlisted code or the repair codes from CPT’s integumentary section. The circumstance of the repair will determine which course of action is best:
- You cannot use the codes for a simple (12001-12007) or intermediate repair (12041-12047), because they specify external genitalia.
- If the repair is due to the original sutures coming loose, you can try 12020 (treatment of superficial wound dehiscence; simple closure).
- Codes 13131–13133 (repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;…) specify only “genitalia,” which includes internal structures of the vaginal canal. However, you may use these codes only if the patient’s record lists the size of the repair and the repair meets the definition of “complex” as outlined in the CPT guideline.
- If the repair is necessary because of an injury, use 57200 (colporrhaphy, suture of injury of vagina [nonobstetrical]).
- If none of these fit, you will be stuck with 58999 (unlisted procedure, female genital system [nonobstetrical]).
- Remember to add modifier -78 (return to the operating room for a related procedure during the postoperative period) if the repair is related to previous surgery and you are in the global period.
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.
Most coders suggest using either an unlisted code or the repair codes from CPT’s integumentary section. The circumstance of the repair will determine which course of action is best:
- You cannot use the codes for a simple (12001-12007) or intermediate repair (12041-12047), because they specify external genitalia.
- If the repair is due to the original sutures coming loose, you can try 12020 (treatment of superficial wound dehiscence; simple closure).
- Codes 13131–13133 (repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet;…) specify only “genitalia,” which includes internal structures of the vaginal canal. However, you may use these codes only if the patient’s record lists the size of the repair and the repair meets the definition of “complex” as outlined in the CPT guideline.
- If the repair is necessary because of an injury, use 57200 (colporrhaphy, suture of injury of vagina [nonobstetrical]).
- If none of these fit, you will be stuck with 58999 (unlisted procedure, female genital system [nonobstetrical]).
- Remember to add modifier -78 (return to the operating room for a related procedure during the postoperative period) if the repair is related to previous surgery and you are in the global period.
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.