Ob-Gyn Coding Alert

Surgeons who perform complex, multistage gynecological procedures typically spend several hours in the operating room and often make critical decisions as they operate. Between assistants at surgery, extra clinical staff, tests and x-rays run during surgery, a tremendous amount of overhead goes into these procedures. Therefore, correct coding is essential to obtaining the maximum reimbursement allowable for such surgeries. Yet multistage surgeries are replete with opportunities to undercode and miss out on critical payments. Proper coding of complicated surgeries means dissecting each stage of the surgery and determining which procedures are bundled with others, and which can be billed separately.

Debbie Vernon, patient account manager with Willowbend Womens Center, a four-physician practice with one nurse practitioner and three triage nurses in Plano, Texas, shares a recent example of a complex surgery her practice completed:

The patient presented with a diagnosis of papillary serous cystadenoma of the right ovary, a right hydrosalpinx with occlusions, a hemorrhagic cyst of the left ovary, periappendiceal adhesions with hemorrhage and endometrial polyps.

Vernons surgeon performed a laparotomy with a right salpingo-oophorectomy and appendectomy, and a left ovarian cystectomy. The surgeon also conducted an extensive lysis of adhesions including enterolysis, myomectomy, a right retroperitoneal dissection and ureterolysis, and a hysteroscopy with D&C (dilation and curettage). The surgeon employed an assistant surgeon during the operative session.

Code Step-by-step

When coding complicated surgeries such as the above example, the first step is to put the procedures in perspective to know if one or more of them may be a bundled procedure. The next step is to verify that all of the procedures are documented in the operative report and then make sure each of the procedures is justified by at least one of the diagnosis codes. Many payers will not reimburse for more than three procedures without either prior authorization or close scrutiny of the claim after the fact. That means submitting thorough documentation with the claim rather than afterwards to expedite payment.

Start by listing the surgical procedures based on the information provided to see what might be missing. Melanie Witt, RN, CPC, MA, an independent coding educator and ob/gyn coding expert, explains her approach to coding a complex surgery such as this. I generally like to use a coding table for the more complicated procedures, Witt says. It helps to quickly clarify what can be coded and in what order the procedures should be listed. Witts coding approach assumes that due to the extensive nature of the surgery, all procedures except for the hysteroscopy were performed through an abdominal incision. Witt has prioritized the [...]