Ob-Gyn Coding Alert

Question: Two of our doctors assisted each other on one patient’s surgery, and I just need some reassurance on how to code this out:

Dr. A performed a Posterior Colporrhaphy
Dr. B assisted

Then the doctors flipped on who was primary and assisting:

Dr. B performed a midurethral sling procedure
Dr. A assisted.

My initial thought is:

Dr. A 57250, 57288-80
Dr. B 57288, 57250-80

But do I need to add a 51 or 59 modifier to any?

Also, normally you do the higher value relative value units (RVU) first which would be 57288, BUT in the two separate reports, you can tell that 57250 was performed before 57288.

Do I bill these out at once or should I keep the two completely separate?

Coding Institute Forum subscriber

Answer: You are correct in your coding. You should report:

Dr. A: 57250 (Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy), 57288-80 (Sling operation for stress incontinence [e.g., fascia or synthetic]; Assistant surgeon)
Dr. B: 57288, 57250-80

Strategy: To simplify matters, you should submit two claims — not put both on the same claim. The modifier 51 (Multiple procedures) is meant for situations where one surgeon performs more than one procedure (but many payers no longer require this modifier).

Watch out: Modifier 59 (Distinct procedural service) would only be appropriate to use if these two codes were bundled (which they are not).