Ob-Gyn Coding Alert

Question: I code for a multispecialty practice. During the course of a laparoscopic assisted vaginal hysterectomy, the ob-gyn lacerated the bladder. He consulted a urologist who came in to repair it, but he was unable to do so. He managed to place a suture using a cystoscope, but that wasn't a satisfactory repair, so he removed the suture and placed a Foley. The patient is following up with the urologist.

I know that coding guidelines say that when a complication arises from a procedure and you-re still in the OR, you should not code the correction of the complication (such as lacerating the uterus during a hysteroscopy andhaving to place a stitch or two in it). But what should I do in this case? Should I report the cystoscope? Or should I just add a laceration-during-a-procedure diagnosis to the lap vaginal hysterectomy?


Arizona Subscriber


Answer: Only Medicare has the rule that the operating surgeon should not report repair of any injury caused during the surgery, but this only applies to the surgeon who created the problem, not another physician who came in to fix the problem.

In your case, the ob-gyn called a urologist in to fix the bladder laceration. The ob-gyn will bill for the laparoscopic assisted vaginal hysterectomy (LAVH) using 58550-58554, depending on the size of the uterus and whether the ob-gyn removed the tubes and ovaries.
 
On the other hand, the urologist can bill the cystoscopy (52000, Cystourethroscopy [separate procedure]), which includes the insertion of the Foley catheter linked to a diagnosis of 998.2 (Accidental puncture or laceration during a procedure).