Ob-Gyn Coding Alert

Question: The physician performed a diagnostic laparoscopy, an excision of endometrial implants and laparoscopically assisted vaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy for endometriosis and uterine fibroids. Can I bill separately for the excision of implants or is that included in the LAVH?

Massachusetts Subscriber

 
Answer: Billing separately for the excision of the implants will depend on their location in relation to the uterus (because this is the reason that organ was removed) and the amount of work involved. In this case you would treat the endometrial implants as if they were adhesions, and if significant work was involved in removing them, you may be able to convince the payer to increase reimbursement. Code this by adding modifier -22 (unusual procedural services) to the primary procedure (58550), not by listing removal of the implants separately. Do not code them at all if the operative report does not show how significant the implant removal was.