Ob-Gyn Coding Alert

Question: I received an op report that states: “Exploratory laparotomy with enterolysis, supracervical hysterectomy BSO, reverse cone biopsy, ureterolysis on the right and scar revision.” I’m confused about the reverse cone biopsy part. Can I bill any of this extra work? Am I stuck with a modifier 22 on 58180?

Georgia Subscriber

Answer: You cannot code this separately from 58180 (Supracervical abdominal hysterectomy [subtotal hysterectomy], with or without removal of tube[s], with or without removal of ovary[s]). You should also not include a modifier 22 (Increased procedural services), because the reverse conization is simply part of the procedure.

A reverse cone biopsy is the same thing as “coring out” the cervix, which is an integral part of the supracervical procedure. A conization of the cervix takes a cone-shaped wedge out from the bottom of the cervix. The reverse conization takes a cone wedge from the cervical walls from above. The ob-gyn doesn’t want to leave any tissue behind that might cause problems later.