Ob-Gyn Coding Alert

Question: My physician did an exploratory laparotomy, bilateral salpingo-oophorectomy (BSO), sigmoid resection and colo-colonic anastomosis with lysis of adhesions. How should I code this?

Pennsylvania Subscriber

Answer: From your description and without seeing the operative report, it appears the physician performed a partial colectomy (44140, colectomy, partial; with anastomosis) when the surgeon resects a segment of the colon and then sutures the two remaining ends together (colo-colonic anastomosis). If there was additional resections of intra-abdominal or retroperitoneal tumors you could also report 49200 (excision or destruction by any method of intra-abdominal or retroperitoneal tumors or cysts or endometriomas) or 49201 (... extensive) depending on the extent of the tumors. Always read the operative report to see if it describes what was done.

The exploratory laparotomy is part of the procedure and would not be coded separately, but the BSO would be coded as 58720 (salpingo-oophorectomy, complete or partial, unilateral or bilateral [separate procedure]). Note, however, that this code is a CPT separate procedure that would require modifier -59 (distinct procedural service) to get it paid if for some reason the payer decided to bundle it with the other procedures performed (Medicare does not bundle these two procedures).

On the claim, list 44140 first because it is the most extensive procedure, followed by 58720-59-51 (-multiple procedures). If you add the code for additional resection, the code order would be 44140, 58720-59-51 and 49200-51 or 44140, 49201-51 and 58720-59-51. You are not likely to be paid for the lysis of adhesions unless they involved significant physician work, but to code for them separately you must know if they were intestinal adhesions or adhesions on the tubes and ovaries. Also remember that each procedure needs to be justified by at least one specific diagnosis code.