Ob-Gyn Coding Alert

The exploratory laparotomy is always bundled into a more extensive procedure, so you would not report it separately, says Terry A. Fletcher, CPC, CCS-P, CCS, a healthcare coding consultant in Laguna Beach, Calif. As for the keloid scar, if it is located where the incision for the current surgery was performed, you will not be reimbursed for it. Therefore, you shouldn't bill separately for it either, Fletcher adds.
 
That leaves 44005, 58720, 58740, and 51860 or 51865. Both 44005 and 58720 are CPT separate procedures."" According to CPT" you should not report separate procedure codes "in addition to the code for the total procedure or service of which it is considered an integral component." NCCI in fact bundles 44005 into 58720 58740 and 51865 so you shouldn't report it separately.

Put the Codes in Order

Based on the Medicare Physician Fee Schedule you should report 58740 first on the CMS-1500 claim form because it carries 14 physician work RVUs unadjusted for region. This makes it the highest-valued procedure Fletcher says. Be sure to link it to the appropriate adhesions diagnosis code(s) for example 614.6 (Pelvic peritoneal adhesions female) and 568.0 (Peritoneal adhesions).
 
Next add 51860 with 12.02 RVUs or 51865 with 15.04 RVUs and link it to 998.2 (Accidental puncture or laceration during a procedure) says Susan E. Callaway CPC CCS-P an independent coding consultant and educator based in North Augusta S.C. If this is a Medicare patient and the physician caused the bladder injury during the surgery the carrier will not reimburse the ob-gyn for repairing it (51860/51865). "Not just Medicare would consider this a non-billable service if created by the surgeon " Callaway says adding that many carriers consider repairing an injury created by the surgeon to be his or her responsibility to repair at no charge. Assuming this was not a Medicare patient you should bill the procedure. But if you know the payer's policy regarding such injuries in advance you should always code with that in mind coding experts say.
 
Next list 58720 with its 11.36 RVUs and include 183.0 (Malignant neoplasm of ovary) as your diagnosis Schraufnagel says. "Although Medicare does not bundle 58720 and 58740 (the primary procedure) according to the NCCI edits some commercial carriers might " Callaway adds.
 
Although you may be tempted to append modifier -59 (Distinct procedural service) to 58720 to indicate that the ob-gyn used the bilateral salpingo-oophorectomy to treat a distinct problem separate from the lysis of adhesions think again. You should use modifier -59 only to bypass an NCCI edit Fletcher says. "Frequently another already established modifier has been defined that describes this situation more specifically. In the event that a more descriptive modifier is available it should be used in preference to the -59 modifier " NCCI instructs.
 
"I would use the -51 modifier (Multiple procedures) as this is a multiple surgical procedure " Fletcher says. Because many carriers will append modifier -51 automatically you may be able to report the codes together without any modifiers she adds. You will be paid 50 percent of the allowable for the second and subsequent procedures. So check with your carriers to determine their modifier -51 requirements.

To summarize to report the procedures outlined in the operative report you should submit 58740 51860-51 or 51865-51 and 58720-51.