Ob-Gyn Coding Alert

Question: Patient had C-section by ob-gyn doctor from an OB practice, and we (GYN/ONC facility) were called in to do the cesarean hysterectomy because of history of metastatic trophoblastic disease. Path report shows no signs of trophoblastic disease. How would this be coded, if the 59525 is an add-on code? They were both from different clinics, so the claims wouldn’t go out together.

Vermont Subscriber

Answer:  The issue is that the code 59525 (Subtotal or total hysterectomy after cesarean delivery [List separately in addition to code for primary procedure]) includes only the intraoperative portion of the surgery and it pays less because the surgeon has already initiated the surgical approach via the cesarean.

As 59525 is an add-on code, there is the assumption that it would only be reported by the surgeon who performs the initial surgery, not a separate surgeon who is not affiliated with the delivering physician.  In this case, you have stated that your physician is not affiliated with the delivering physician and this will allow you to bill 58150-52 (Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s] – reduced service). The modifier 52 (Reduced services) is required because your physician did not open or close.