Ob-Gyn Coding Alert

Question: My ob-gyn performed a laparoscopy, exploratory laparotomy and left ovarian endometrioma resection. Should I report this as 49200 and 49320-51? Ohio Subscriber Answer: The answer depends on the payer, because in this case the ob-gyn appears to have originally planned to remove the left ovarian endometrioma laparoscopically. If this is a Medicare patient, code only the open procedure (49200, Excision or destruction, open, intra-abdominal or retroperitoneal tumors or cysts or endometriomas).

If this is not a Medicare patient, you have two options. You can code for the intended failed procedure in this case, 58662-52 (Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method; reduced services) if the surgeon had begun part of the procedure before converting to the open approach, plus the final approach procedure (49200). Or you can bill the final approach procedure (49200) appended with modifier -22 (Unusual procedural services).