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 with a V64.41?

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 -look-see- 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 celiotomy with or without biopsy[s] [separate procedure]) is included in an open procedure. In this case, you-d represent this -look-see- part of the procedure with 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), but you should not separately bill 49320.

In other words, you should go with the 58720-22 (Salpingo-oophorectomy, complete or partial, unilateral or bilateral [separate procedure]; unusual procedural services) only and include V64.41 (Laparoscopic surgical procedure converted to open procedure) as one of the diagnoses. 

Don't forget: As you pointed out, the Correct Coding Initiative (CCI) permanently bundles 44005 (Enterolysis [freeing of intestinal adhesion] [separate procedure]) into 58720.  Modifier 22 is the way to go to account for the extra work associated with the laparoscopic procedure and the adhesiolysis.