Ob-Gyn Coding Alert

Question: Where can I find relative value units (RVUs) for procedures? I billed 49322 (laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst]) with 58925 (ovarian cystectomy, unilateral or bilateral) as the secondary procedure. Blue Cross Blue Shield reversed them and allowed $800 for the 58925 and $408 for the 49322. I thought that the higher-priced procedure is always billed as the primary. Am I correct?

Florida Subscriber

Answer: You can get RVUs by accessing the Medicare Physician Fee Schedule at www.hcfa.gov/medicare/pfsmain.htm. Click on "2002 National Physician Fee Schedule Relative Value File,'' then select file RVU02_a.zip and follow the prompts to download it. The easiest format in the zip package for viewing the fee schedule is pprrvu02.xls, which requires Excel or an Excel viewer. Other files in the zip package include the appendix that explains each indicator in every field.
 
It might be incorrect to bill a laparoscopic ovarian aspiration and an open ovarian cystectomy together. If a cyst was aspirated on one ovary and then a cyst was removed from the opposite ovary, both through the laparoscope, the code for the cystectomy would be 58662 (laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method), and you could also bill for the 49322. But if the cyst was first aspirated and removed (from the same ovary) via the scope, only 58662 would be reported.
 
The RVUs for 49322 are 10.14, while the cystectomy code carries 18.53 RVUs, so it looks as if your practice's fee structure may be out of kilter. The RVUs for 58662 are 18.56.

Answers to Reader Questions and You Be the Coder provided by Melanie Witt, RN, CPC, MA, an independent coding consultant and ob/gyn coding expert based in Fredricksburg, Va.