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Ob-Gyn Coding Alert

READER QUESTION:

Get Right to Your RSO, Laparotomy Code

Published on Mon Jan 01, 2007

Question: My ob-gyn performed a laparoscopic right salpingo-oophorectomy (RSO) and then noted bleeding from the right inferior epigastric artery. So he performed a mini laparotomy as well. How should I report this? Should I use 49000 with a diagnosis of 998.11, or should I use modifier 22 on 58661?


New Hampshire Subscriber


Answer: You should report 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) with modifier 22 (Unusual procedural services) appended. You will also add a secondary diagnosis for the hemorrhage during the procedure using 998.11 (Hemorrhage complicating a procedure), as you have indicated. 

Heads up: You cannot report 49000 (Exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]) because this code represents an exploratory procedure that is integral to the laparoscopic procedure an ob-gyn performs.

The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M.
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