Ob-Gyn Coding Alert

Question: What are the appropriate codes for a Moschowitz procedure and ovarian drilling for multiple tiny cysts?

Mississippi Subscriber  
Answer: A Moschowitz is an abdominal approach enterocele repair that is coded 57270 (repair of enterocele, abdominal approach). It is also a CPT separate procedure that may be bundled when performed with other procedures because this code designation means it is normally an integral part of another larger procedure, and many insurers interpret that to mean with any other procedure. 
 
An enterocele repair is also frequently denied if the procedure is done to prevent rather than to repair an enterocele. In general, when billing this procedure for the repair of an existing enterocele, you may want to add modifier -59 (distinct procedural service) to 57270 to let the payer know this is really a distinct procedure. (See your CPT book for a more detailed explanation of this modifier.) There is no code specific to ovarian drilling, but the closest is 58805 (drainage of ovarian cyst[s], unilateral or bilateral; abdominal approach), or 49322 (laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]) if done laparoscopically.