Ob-Gyn Coding Alert

Question: I have an op report that states the ob-gyn did a hysteroscopy, converted to laparoscopy with bilateral tubal ligation and cauterization of perforation of uterus.

When I start reading the op note it states: “After adequate dilation, the hysteroscope was introduced. On using the hysteroscope, the uterine cavity was surveyed and a loop of bowel was seen. At this point, the hysteroscopy procedure was abandoned, and a decision was made to convert the procedure to laparoscopic bilateral tubal ligation and repair of uterine perforation. Tubes were visualized and cauterized. The endoscopic scissors were introduced, and the cauterized portion was cut.”

How should I report this?

Wyoming Subscriber

Answer: The ob-gyn can only bill the final procedure, and since the hysteroscope was simply inserted to start the procedure, you will add a modifier 22 (Increased procedural service) to the final laparoscopic approach (58670, Laparoscopy, surgical; with fulguration of oviducts [with or without transection]). 

You won’t find any code for uterine repair via the laparoscope, so you should bill 58578-51 (Unlisted laparoscopy procedure, uterus; Multiple procedures) and compare the work to 58520 (Hysterorrhaphy, repair of ruptured uterus [nonobstetrical]), or account for the additional work via the modifier 22 on 58670 instead.