Ob-Gyn Coding Alert

Question: When billing a diagnostic laparoscopy with lysis of adhesions (58660) along with a laparoscopy with aspiration of a cyst (49322), should the second procedure have a -51 or -59 modifier?

Alabama Subscriber

Answer: The most extensive procedure is always listed first on the claim form. In this case, the laparoscopic lysis of adhesions (58660, laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]) is the higher valued code so it will be listed first with modifier -59 (distinct procedural service) to let the payer know that it was distinct from the aspiration as it is listed in CPT as a separate procedure. Code 49322 (laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]) will be listed second with modifier -51 (multiple procedures).

If the values of these two procedures had been reversed so that the second code listed was the separate procedure code that required the -59 to get it paid, you would list both modifiers on the second code, but list -59 first. The -59 modifier tells the insurance payer that you should be reimbursed for the service, and the -51 indicates how much.

Note: For more on this topic, see Ob-Gyn Coding Alert October 2000, page 75.