Ob-Gyn Coding Alert

Question: My ob-gyn’s documentation shows he laparoscopically removed the patient’s fallopian tubes but saved the ovaries. Then he documented an ablation of the ovarian wall for endometriosis. What modifier should I use when billing for these two procedures?

Iowa Subscriber

Answer: If he removed the tubes (instead of removing a cyst on the tubes), then you should code 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]). For ablation of endometriosis, you should submit 58662 (...with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method).

The Correct Coding Initiative (CCI) does not bundle these codes. So you would apply modifier 51 (Multiple procedures) to 58661.

Some coders report, however, that McKesson edits are bundling these two procedures for some payers. McKesson is a clinical editing system that is not in a public domain, and therefore you are not given specific information about what edits your payer is applying each time you bill.

Most of the time, you learn what they are by following the denial patterns. When your payer bundles 58661 and 58662 and you know the surgery is in two different places, you would tack on modifier 59 (Distinct procedural service) to the code the payer is bundling.