Coding From the Doctor's Note:
3 Steps Resolve Your Endometrial Cancer Questions
Published on Wed Sep 17, 2008
Hint: Use a modifier with an existing code to reflect partial work Complicated endometrial cancer surgeries never entail easy codes, but you can skip the denials and recoup the reimbursement your physician deserves using three simple steps. Heads up: When you read the following op note, keep an eye out for whether the ob-gyn converted a laparoscopic to an open procedure. Review This Op Note Preoperative diagnosis: Adenocarcinoma of the endometrium. Postoperative diagnosis: Same as above, but greater than 50 percent myometrial invasion, pathology pending. Operation performed: Laparoscopic assisted transvaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy, laparotomy with pelvic and periaortic node dissection, partial omentectomy, pelvic washings. Procedure: Exam of the pelvic organs revealed an 8-week-size uterus. The right and left ovaries appear to be within normal limits. The ob-gyn found no evidence of excrescences or signs of metastatic disease in the lower pelvis along the bowel or serosa, nor did he discover evidence of metastatic disease in the upper abdomen, liver and dome of the diaphragm. He then performed a dissection. He removed the uterus vaginally with the assistance of the laparoscope, and the pathologist was present to open the organ and render an opinion. The pathologist saw an enlarged, fungating, relatively superficial lesion of the endometrium. Up in the patient's right fundal area, however, the pathologist saw an invasion of the myometrium at least two-thirds of the way through. The ob-gyn performed a laparotomy and pelvic node dissection. He removed the laparoscope and made a new incision to enter the peritoneum. He obtained pelvic washings from the right cul-de-sac and pelvic area. He then performed a partial omentectomy with the aid of multiple Kelly clamps. The ob-gyn did a pelvic node dissection, first on the right side identifying the ureter evenly. He carried down the dissection to include the internal and external iliac lymph nodes. He performed the same procedure on the left side. The dissection took place below the bifurcation of the aorta. The ob-gyn obtained tissue in the periaortic lymphatic chain area. Step 1: Decipher the LAVH Approach The first thing you must do is decide whether your ob-gyn used two different surgical approaches -- laparoscopic and abdominal. Keep in mind: "Laparoscopic" means that the ob-gyn made several small incisions through which he can pass a fiber-optic scope and any required instruments to complete the surgery, says Arlene J. Smith, CPC, insurance, coding and billing specialist for Tacoma Women's Specialists in Washington. "Laparotomy," on the other hand, means that the ob-gyn made an incision into the abdominal wall. Result: The ob-gyn did not complete the procedure via laparoscopy but, rather, performed an additional procedure abdominally separate from the laparoscopic surgery. But you-ve got a problem. If you [...]
