Ob-Gyn Coding Alert

Question: I know that the code for the treatment of ectopic pregnancy is 59150 when done laparoscopically, but the provider ended up doing an open salpingostomy, which would be 58770. The problem is that Medi-Cal does not cover the 58770 at all. Is it okay to bill the 59150 instead? Otherwise it is a free procedure, because you can’t balance bill the patient for non-covered services. I know you can’t change codes just to get paid, but he did start out doing the laparoscopy, so I thought I would ask. What should I do?

Washington Subscriber

Answer: The ob-gyn converted the procedure, so you bill the final code — which is 59121 (Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy) in this case. The physician has to make a hole (the ostomy) into the fallopian tube to remove the ectopic, and that is what this code describes. You can add a modifier 22 (Increased procedural service) to cover the additional work of starting the procedure laparoscopically, but the ob-gyn did not actually perform a diagnostic laparoscopy, as he knew it was ectopic and planned on removing it that way.