Ob-Gyn Coding Alert

Question: My physician was called to the operating room to consult on a patient. He took over the laparoscopy and removed a corpus luteum cyst. He wants to charge for an intraoperative consult, diagnostic laparoscopy, and a postoperative consultation two days later. Is this correct?

New Jersey Subscriber

Answer: You can bill for the inpatient consultation done just prior to doing the surgery (99251-99255, Initial inpatient consultation for a new or established patient ) with modifier -57 (Decision for surgery) if that is when the decision was made. Because he removed a corpus luteum cyst, he will be billing for this procedure rather than a diagnostic laparoscopy (49320, Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

The code you use depends on the documentation. If the physician removed part of the ovary along with the cyst, 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) would be correct. If the cyst was removed intact, use code 58662 (... with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method). Because your surgeon performed the procedure after another physician inserted the laparoscope, modifier -52 (Reduced services) should be added.

A note of caution: Unless your physician was asked by the other physician to do another consultation postoperatively, that cannot be billed for because the payer will consider the visits part of the global surgical package for the procedure he performed. If you feel you can bill for the follow-up consultation, make sure your physician has documented the request in the medical record and that the requesting physician has seen the result of the consultation in writing (shared hospital record, copy of the record or letter).