Ob-Gyn Coding Alert

Question: The ob-gyn performed a bilateral salpingo-oophorectomy (BSO). This began laparoscopically and converted to an open. Patient had extensive filmy and dense adhesions. The ob-gyn wants to bill for both procedures (49320, 58720 and 44005), which I know is not allowed. My understanding is that when the procedure is laparoscopic and converts to an open, I should go with the most extensive procedure. Or should I bill for the 49320-53? South Carolina Answer: The answer depends on what he did through the scope, but the modifier would be modifier 52 (Reduced services), not 53 (Discontinued procedure). Using modifier 53 means that the ob-gyn stopped all surgery, and the patient went to recovery. If the ob-gyn dictated the laparoscopic portion was the "looksee" part of the procedure and then he converted before doing anything else, you should consider that portion as part of the procedure, just as 49000 (Exploratory laparotomy, exploratory [...]