Ob-Gyn Coding Alert

Meeting the multifaceted needs of women patients, the ob/gyn often performs more than one service or procedure on the same day, or during the same global surgical period. Unfortunately, reporting extra activity cannot be accomplished by simply stacking the procedure and service codes or submitting a bill that ignores additional activity. The services and procedures have to be reported with the help of modifiers. The most commonly used (and perhaps most misunderstood) modifiers to report these circumstances are modifiers -51, -58, -59 and -79.

Theres still a lot of confusion around these modifiers, says Becky Dawson, CPC, compliance education specialist for the Department of Surgery Corporation of Columbus, OH.

Modifier 51: Multiple Procedures

This modifier is used for multiple procedures performed on the same day or at the same session by the same provider. For example, if the physician performs a vaginal hysterectomy, and during that same session performs an anterior and posterior colporrhaphy, this qualifies as multiple procedures and may be reported using the -51 modifier.

The 1999 CPT clarifies the use of this modifier by saying that in using -51, coders must report the most significant procedure first, with all other procedures listed with the -51 modifier appended. Therefore, report the vaginal hysterectomy (58260) first without the modifier and then the combined anteroposterior colporrhaphy (57260) with the -51 modifier.

There are codes with which you should not use the -51 modifier, such as add on codes and assorted other. The -51 modifier also is not meant to be used with Evaluation and Management Services. But the new 1999 CPT makes this exclusion easier to understand by identifying the add-on codes with a big + symbol, and other codes excluded from -51 modifier use with the W symbol. In addition, all of these codes excluded from the -51 modifier are listed in CPTs Appendices E and F.

According to Dawson, the -51 modifier receives mixed acceptance from payers. Some carriers are asking that it not be used, she says. If you are experiencing denials, check with your payers.

Modifier -58: Staged or Related Procedures

A common situation in ob/gyn practices that signals the need for modifier -58, Dawson says, is when a lump or growth is biopsied and then the patient goes back for more surgery during the same global period. Offering some clarification, the 1999 CPT states that the -58 modifier is used when a procedure(s) 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 In other words, modifier -58 should be used if a procedure, performed by the same physician during the postoperative period, is:

A) Planned prospectively at the time of the original [...]