Ob-Gyn Coding Alert

Question: Doctor performed a right ovarian cystectomy on a 17 weeks pregnant patient. We have started her global package, so do I need to add a modifier to unbundle it?

Coding Institute Forum Contributor

Answer: The right ovarian cystectomy is not related to ob global care. Therefore, you should not need a modifier because the patient is still pregnant and the surgery takes place prior to the date of delivery.

If a payer does require a modifier, you should use modifier 79 (Unrelated procedure or service by the same physician or Other Qualified Health Care Professional during the postoperative period) if the same physician who is providing ob care is also doing the surgery (or a member of the same practice). A modifier would never be required if the surgeon for the cystectomy is not in the same practice as the ob physician.

Simply code the procedure (such as 58925, Ovarian cystectomy, unilateral or bilateral), but the diagnosis will be O34.82 (Maternal care for other abnormalities of pelvic organs, second trimester) since the surgery would put the pregnancy at risk. Your secondary diagnosis will be the type of cyst that was removed (probably a N83.- code, Noninflammatory disorders of ovary, fallopian tube and broad ligament …).