Ob-Gyn Coding Alert

" Ob/gyns often perform more than one service or procedure on the same day or during the same global surgical period, and choosing the right modifier can be maddening. Modifier -51: Multiple Procedures According to CPT: Coders must report the most significant procedure first" with all other procedures listed with modifier -51 appended."

There are certain circumstances when modifier -51 should not be used. For example it should not be used with add-on codes or E/M services. CPT identifies an add-on code with a + symbol and other codes excluded from modifier -51 use with the msymbol. In addition all of these excluded codes are listed in CPT's appendices E and F. If your ob/gyn performs multiple procedures on the same day at the same session you should report this modifier. "For example when performing multiple ultrasounds our office will use modifier -51 as follows: complete ultrasound (76805) performed with a biophysical profile (76818) reported as 76805 76818-51 " says Brenda Dombkowski CPC Obstetric-Gynecology & Infertility Group Cheshire Ct. Modifier -58: Staged or Related Procedure CPT directs that modifier -58 should be used "when a procedure(s) or service is prospectively planned as a staged procedure or when the secondary and subsequent procedure(s) is more extensive or to indicate therapy following a diagnostic surgical procedure " To clarify further modifier -58 should be used if a procedure performed by the same physician during the postoperative period is: 1. Planned prospectively at the time of the original procedure (staged). For instance the patient needs to have tandems and ovoids (57155) inserted and the physician plans to insert them on two separate dates (e.g. two weeks apart). In this case the same code is billed each time but on the second date of service append modifier -58 to 57155. 2. More extensive than the original procedure. Dombkowski offers the following illustration: A physician performs a diagnostic hysteroscopy with a D&C (58558) on a patient with postmenopausal bleeding and an abnormal ultrasound revealing a possible growth. The surgeon does not suspect cancer but the pathology report reveals endometrial carcinoma. The doctor schedules a radical TAH/BSO with bilateral lymphadenectomy (58210) three days later and reports 58558 and 58210-58. If cancer is suspected and the surgeon plans the biopsy as the first step to proceeding to cancer surgery this is also an example that would apply to the first criterion for this code (staged procedure). 3. For therapy following a diagnostic surgical procedure. Dombkowski says that the following situation warrants the use of modifier -58: A physician performs a diagnostic D&C (58120). Pathology reveals CIN III. The doctor then performs a conization of cervix (57520). Report 58120 and 57520-58. Modifier -59: Distinct Procedural Service Modifier -59 [...]