Ob-Gyn Coding Alert

Question: The ob-gyn performed difficult open laparoscopy, hysteroscopy, chromotubation, enterolysis, fimbriolysis, salpingolysis, ovariolysis, hydropertubation and fimbrioplasty for infertility (pelvic adhesions, peritoneal adhesions and endometriosis of Douglas'cul de sac). I reported this as 44200-22, 58672-22, 58558, 58660-22 and 58350. Are my codes and order correct? Should I also report the open laparoscopy or is the modifier -22 on 44200, 58672 and 58660 sufficient?

Rhode Island Subscriber

Answer: Although you have separately listed the code for lysis of adhesions (58660, Laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]), you may not get reimbursed for it because payers generally bundle it into the other procedures you are reporting. In addition, because you can bill for adhesiolysis only when it is extensive, you should never bill this code with modifier -22 (Unusual procedural services).

Based on the information provided, the ob-gyn performed an open laparoscopy. This may warrant using modifier -22, but you should use it only on the primary code. In this case, you should report 58672-22 ( with fimbrioplasty). You should also add modifier -50 (Bilateral procedure) if the ob-gyn performed the procedure on both sides. This code would cover the open laparoscopy procedure as well as the adhesiolysis that the surgeon did around the tubes and ovaries.

The payer also may allow you to bill separately for the enterolysis with 44200 (Laparoscopy, surgical; enterolysis [freeing of intestinal adhesion] [separate procedure]). You may have to add a modifier -59 (Distinct procedural service), depending on the carrier, even though the national Correct Coding Initiative does not bundle 44200 with 58672. If the ob-gyn performed the enterolysis as part of the open laparoscopy, the code order now would be 44200-22, 58672-22 (modifier -22 added for the lysis of adhesions, not the open procedure) and 58350*-51 (Chromo-tubation of oviduct, including materials; multiple procedures) for the chromotubation, assuming the physician performed it to diagnose the problem and not check his or her work after completing the procedure.

The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.