Ob-Gyn Coding Alert

Question: My ob-gyn performed the following procedure: "Total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic washing, partial omentectomy, and diaphragmatic scraping for partial staging." He did not do any lymph node sampling. What should I report?

New York Subscriber

Answer: The best option is to report 58150 (Total abdominal hysterectomy [corpus and cervix],with or without removal of tube[s], with or without removal of ovary[s]). To cover the omentectomy and diaphragmatic scrapings (but the pelvic washings are included in 58510), you should append modifier 22 (Increased procedural service). This is because omentectomy is always bundled into abdominal procedures such as this one, and no modifier can be used to report it separately. CPT designed modifiers to represent the extra physician work involved in performing a procedure because of extenuating circumstances present in a patient encounter. Modifier 22 represents those extenuating circumstances that don't merit the use of an additional or alternative CPT code, but instead raise the reimbursement for a given procedure.

Modifier 22, the op report, and a letter sent with the claim will indicate to the carrier that additional reimbursement is in order for the extra work involved.

Tactic: The key to collecting reimbursement for unusual procedures is all in the documentation. Sometimes a physician will tell you he did "x, y, and z," but when you look in the documentation, the support isn't there. Documentation is your chance to demonstrate the special circumstance that warrants modifier 22.

Being straightforward also helps. Don't forget to add on the additional dollar amount what you are asking for. Payers just don't pay you extra with this modifier. You need to say, "I am asking for ____ extra and this is why."