Ob-Gyn Coding Alert

Question: One of our ob-gyns was performing a loop electrosurgical excision procedure with conization in the office, and the patient would not stop bleeding. So he took her to the operating room for endocervical curettage. Should I append modifier -78 to the curettage code?

California Subscriber

Answer: Because the physician performed the endocervical curettage to control bleeding, many payers may consider this to be part of the procedure. So don't be surprised if you have problems getting this paid.
 
Keep in mind that although the National Correct Coding Initiative does not bundle 57505 (Endocervical curettage [not done as part of a dilation and curettage]) into 57522 (Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision), CPT states that you cannot report a colposcopic loop conization with an endocervical curettage. Payers may apply this same logic to 57522 as well because the procedures are identical except for using the colposcope.
 
Instead of adding modifier -78 (Return to the operating room for a related procedure during the postoperative period) to 57505, consider modifier -59 (Distinct procedural service) to let the payer know that the ob-gyn performed this service at a different surgical session if he did it within hours of the conization.
 
In any case, you should include a letter with the claim explaining the problem the surgeon encountered and why he chose to perform the endocervical curettage. Although modifier -78 may work, some payers deny the service with this modifier when reported on the same date as the original surgery when the second surgery was to control bleeding.