Ob-Gyn Coding Alert

Question: The ob-gyn performed a laparoscopic salpingoneostomy and a partial salpingectomy. How should I code this?

Washington Subscriber

Answer: The National Correct Coding Initiative bundles the salpingoneostomy with a salpingectomy because the salpingectomy is the "most extensive procedure." The good news is that you can bypass this edit using a modifier if the surgeon performed the partial salpingectomy on one fallopian tube and the salpingoneostomy on the other tube.

You would report the primary procedure as the partial salpingectomy with 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) and the salpingoneostomy with 58673 (... with salpingostomy [salpingoneostomy]). You should either add modifier -59 (Distinct procedural service) to 58673 or use the anatomic modifiers -LT (Left side) or -RT (Right side) to indicate that the physician performed a different procedure on each fallopian tube. But be sure that the ob-gyn's documentation supports that he performed the procedures on different sides, and be prepared to appeal if the carrier denies the claim.
 
If the doctor performs the procedures on the same tube, however, you can code only one procedure. You should be aware that 58673 has a higher relative value than 58661, according to the Medicare Physician Fee Schedule.