Ob-Gyn Coding Alert
Weigh This Potential Modifier 22 or Modifier 52 Situation
Question: My ob-gyn is performing 58200, but in addition, he is removing the pelvic lymph nodes. He wants to bill 38770 in addition. Would this be included in 58200? Can we add modifier 22 to the 58200? Florida Subscriber Answer: Code 58200 (Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube[s], with or without removal of ovary[s]) includes sampling of the pelvic and para-aortic nodes. However, the ob-gyn apparently did not do a para-aortic sampling (which is required), but he took all the pelvic nodes instead of just a sampling (you need to verify this). So on one hand he did less than described by the code, and on the other, he did more. So you would have to bill 58200-52 (Reduced services) if you also want to report 38770 (Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes [separate procedure]). Or you would add a modifier 22 (Increased procedural service) to 58200. Your choice, but either way, the claim will need to be reviewed.
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