Ob-Gyn Coding Alert

Question: When I bill a diagnostic laparoscopy with lysis of adhesions (58660) along with a laparoscopy with aspiration of a cyst (49322), should the second procedure have a -51 or -59 modifier?

Alabama Subscriber

Answer: You should always list the most extensive procedure first on the claim form. In this case, the laparo-scopic lysis of adhesions (58660, Laparoscopy, surgical; with lysis of adhesions [salpingolysis, ovariolysis] [separate procedure]) is the higher-valued code, so you should list it first with modifier -59 (Distinct procedural service) to let the payer know that it was distinct from the aspiration because it is listed in CPT as a "separate procedure." You should report 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]) second with modifier -51 (Multiple procedures).

If the values of these two procedures had been reversed so that the second code listed was the "separate procedure" code that required the -59 to get it paid, you would list both modifiers on the second code, but list -59 first. Modifier -59 tells the insurance payer that you should be reimbursed for the service, and the -51 indicates how much. Note that some payers do not require you to use modifier -51 along with -59. But unless you know this to be true, you should err on the side of completeness.