Ob-Gyn Coding Alert

Question: Our ob-gyn's patient underwent a laparoscopic assisted transvaginal hysterectomy (LAVH) and a partial laparoscopic omenectomy. What code should I report?

New Mexico Subscriber

Answer: You have no code for a laparoscopic omentectomy -- partial or total.

Option 1: One option is to use an unlisted procedure code (49329, Unlisted laparoscopy procedure, abdomen,peritoneum and omentum). Both CPT and CMS guidelines specifically instruct providers to use an unlisted procedure code when no available code describes the specific procedure your ob-gyn performs.

CPT 2009, for instance, states, -A service or procedure may be provided that is not listed in this edition of the CPT codebook. When reporting such a service, the appropriate -Unlisted Procedure- code may be used to indicate the service ...- More specifically, proper coding practice dictates that if the ob-gyn performs a laparoscopic procedure and there is no laparoscopic code, you should use the unlisted procedure code for that body area. You should not use a comparable open code.

Tip: If you want to gain appropriate payment for an unlisted-procedure claim, include documentation to compare the reported unlisted procedure to the next closest procedure that appears in CPT. In this case, you would use the open code for an omentectomy (49255,Omentectomy, epiploectomy, resection of omentum [separate procedure]) and have your physician tell the payer whether the laparoscopic procedure involved the same work, less work, or more work.

Option 2: Another option is to add modifier 22 (Increased procedural services) to the LAVH code you bill (such as 58552, Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 grams or less; with removal of tube[s] and/or ovary[s]). Your payers will expect yourdocumentation to support significant additional work.

Good advice: Send a brief note and a copy of the operative report to substantiate the request for additional reimbursement.