Ob-Gyn Coding Alert

Question: I-ve got two codes with similar descriptions. What is the difference between S2078 and 58541? Also, my doctor did a laparoscopic supracervical hysterectomy (LSH) with extensive lysis of adhesions and had a first assist from an ob-gyn from another practice. During the same surgery, a urologist performed ureterolysis of the left ureter. Should I report 58541-22 (for lysis of adhesions) with a modifier 80? Is that right? Or can I code for the adhesions separately?

Arizona Subscriber

Answer: First, S2078 (Laparoscopic supracervical hysterectomy [subtotal hysterectomy] with or without removal of tube[s], with or without removal of ovary[s]) is the code you would report to Blue Cross Blue Shield (BCBS). But BCBS may delete this code at some point because you have the new CPT codes for the procedure (discussed below), which CPT added this year. As you can see by the definition, S2078 includes a bilateral salpingo-oophorectomy (BSO), if performed, but does not allow you to differentiate between a large or normal sized uterus.

In contrast, 58541 (Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less) does not include a BSO. Notice: The descriptor specifies a uterus of less than 250 grams.

Second, the Correct Coding Initiative (CCI) allows modifier 59 (Distinct procedural service) on either 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]) or 58660 (Laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]) when you bill one of these codes with 58541.

Important: You need to know where the adhesions were. To meet the code descriptions, they would have to be in a different area. In other words, you should include lysis of uterine adhesions, but if the ovaries and tubes were stuck to the pelvic sidewall, you should not include them because the ob-gyn was not performing a BSO.

In conclusion, if you have documentation to support extensive intestinal and ovarian/tubal adhesiolysis, you can report either or both 44180-59 and 58660-59 with 58541 instead of 58541-22 (Unusual procedural service). The urologist, of course, can bill separately for his part of the procedure (the ureterolysis), assuming the documentation supports a diagnosis of retroperitoneal fibrosis or ovarian vein syndrome (593.4, Other ureteric obstruction).

Don't forget: You will place the assistant modifier (80, Assistant surgeon; or 81, Minimum assistant surgeon, in a teaching hospital situation) as well as modifier 22 on each service the assistant helped with.

Check your documentation.