Ob-Gyn Coding Alert

Get to the nitty-gritty of enterocele combos -- and get the payment you deserve Last month, you learned how to use approach, uterine size/weight and extent to report hysterectomies -- but that's only part of your code selection process. To get these codes right every time, you-ve got to take into account additional procedures your ob-gyn may perform. Begin With Burch Code Choices First, when your ob-gyn performs a bladder and/or urethra fixation for stress incontinence in addition to a hysterectomy, you-ve got three coding options. And depending on the fixation point, your physician will refer to this as a -Marshall-Marchetti-Krantz,- -Burch- or -Pereyra- procedure, says Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M. For an abdominal approach, you should use 58152 (Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]; with colpo-urethrocystopexy [e.g., Marshall-Marchetti-Krantz, Burch]). For a vaginal approach, you-ll use 58267 (Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy [Marshall-Marchetti-Krantz type, Pereyra type] with or without endoscopic control) or 58293 (Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy [Marshall-Marchetti-Krantz type, Pereyra type] with or without endoscopic control). Notice how you-ll choose the correct vaginal approach code based on weight: 250 grams or less, or greater than 250 grams. Revisit Your Vaginectomy Options Hysterectomies involving partial or total vaginectomies (colpectomies) have codes of their own. For example, if your ob-gyn performed an open hysterectomy, you should use 58200 (Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube[s], with or without removal of ovary[s]). Code 58200 represents removing the uterus as well as neighboring areas (the parametrium and uterosacral ligaments) and includes a partial vaginectomy. Ob-gyns perform this procedure when endometrial cancer has spread to the cervix or parametrium, Witt says. Keep in mind: Code 58210 (Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling [biopsy], with or without removal of tube[s], with or without removal of ovary[s]) also includes a vaginectomy -- -upper one-third of the vagina, to be exact,- Witt says. If the ob-gyn performed this via a vaginal approach, you-ll use either 58275 (Vaginal hysterectomy, with total or partial vaginectomy), 58280 (... with repair of enterocele), or 58285 (Vaginal hysterectomy, radical [Schauta type operation]). Latch Onto These Lymph Scenarios When an ob-gyn performs a para-aortic and pelvic lymph node sampling, he's performing a lymph node biopsy. He can perform this only via an abdominal approach. For this service, you-ll report 58200. You-ll see this service referred to as a -modified radical- abdominal. This includes a partial vaginectomy. On the other hand, if your ob-gyn performs a [...]