Ob-Gyn Coding Alert

Question: Our ob-gyn performed a laparoscopic sacrocolpopexy (LSC) converted to open laparotomy for bilateral salpingectomy and hysterotomy repair. The diagnosis states "left ruptured ectopic pregnancy located at the level of the isthmus, salpingectomy due to undesired fertility and hysterotomy repair." Would the correct codes be 58720 and 59130(51) for the repair?

Wisconsin Subscriber

Answer: If he had done this laparoscopically, the code for the entire procedure would have been 59151 (Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy) which has 21.62 relative value units (RVUs).

As he converted, you can bill out each part of the surgery separately, but you need to refer to the op note to determine whether this can be called an abdominal pregnancy. The reason is the isthmus of the uterus is just above the cervix, so without seeing the op note, this answer is not certain.

So you might be stuck with just the repair of the uterus code (59350, Hysterorrhaphy of ruptured uterus) plus the salpingectomy (58720, Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)).