Ob-Gyn Coding Alert

Question: When our ob-gyn performed a diagnostic laparoscopy, he decided to proceed with a laparotomy and reanastomosis. During the laparotomy, however, he found that he could not reconnect either tube. Should I code this as 58750-53 and 49320-51?

Nebraska Subscriber

Answer: You should use modifier -53 (Discontinued procedure) only when the surgeon stops the entire procedure and takes the patient to recovery because of her condition (such as a drop in blood pressure). On the other hand, you should use modifier -52 (Reduced services) for a failed procedure when the ob-gyn could not complete the originally planned surgery.

Whether you can bill for the diagnostic laparoscopy will depend on the documentation. Many payers will only reimburse for the final approach and will consider the laparoscopy a "look see" that they include in the payment for the final procedure.

Keep in mind, however, that some payers will accept the final approach code with modifier -22 (Unusual procedural services) for the extra work the physician performed during the laparoscopy. But you probably won't be able to bill both modifier -22 and modifier -52 with the same code. Consequently, you should submit 58750-52 (Tubotubal anastomosis) and possibly 49320-51 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]; multiple procedures) if you think you can make a case for billing a diagnostic laparoscopy separately.

Most coding experts would not recommend that you use modifier -59 (Distinct procedural service) with 49320 because the diagnostic laparoscopy is not normally an integral procedure to an open approach anastomosis and therefore does not fully meet the definition for using this modifier.

-- 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.; and Peggy A. Stilley, CPC, office manager for Women's Healthcare Specialists, an Oklahoma University-based private ob-gyn practice in Tulsa.