Challenge: Take what you-ve learned and tackle this second scenario Coding op notes doesn't have to overwhelm you if you can order your coding choices, spot bundled codes, and pinpoint necessary modifiers. Break down this example into five simple steps, and you-ll steer clear of reimbursement complications Op note example: Your ob-gyn did a surgery using a laparoscopic approach. His documentation states, -Pre-op diagnosis: Painful left ovarian cyst. Procedures in order performed (two auxiliary ports): 1. Left ovarian cystectomy
2. Sharp dissection of dense adhesions from sigmoid to left adnexa and posterior uterus involving 1 hour of additional time to remove
3. Destruction of endometriosis left pelvic sidewall, vesicouterine reflection, and posterior cul-de-sac.- Step 1: Rank Codes in RVU Order First, you should identify all the procedures your ob-gyn performed by allotting them a code. Place these codes in order of their relative value units (RVUs), listing the highest value code first. Don't forget to append the appropriate modifier to all subsequent procedures unless they are represented by add-on codes, says Rebecca Lopez, CPC, certified coder at Bright Health Physicians in Whittier, Calif. For the left laparoscopic cystectomy, you would report 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) if the ob-gyn removed part of the ovary along with the cyst. If the ob-gyn removed the cyst intact, you would report 58662 (... with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method) for both the cyst and the destruction of the endometriosis. As for the lysis of adhesions part of this procedure, you would report 58660(... with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]). So that's 58661, 58662, and 58660, or possibly just 58662 and 58660. According to the RVU scale, the code 58662 has more work RVUs (12.08) than 58661 (11.30), so you should report that code first. Step 2: Eliminate Surgical Standards Review your list of codes. Identify and eliminate those codes that are surgical standards (such as those for exploratory laparotomy, diagnostic laparoscopy, diagnostic hysteroscopy, exam under anesthesia, surgical access, integral procedures, hemostasis control, drain placement, a procedure checking the surgeon's work, and so on). You shouldn't list codes for these inherent services when performed with other surgical procedures. Impact: You shouldn't report 58660 in the previous surgical scenario because this code is a -separate procedure.- CPT considers this an integral component of some larger procedure Therefore, you shouldn't report it in addition to the code for the total procedure. Step 3: Note Any CCI Edits Check the Correct Coding Initiative (CCI) for coding edits. Note: You can see the edits online at
www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp. Eliminate code combinations CCI won't allow [...]
