Ob-Gyn Coding Alert

Question: The physician performed a diagnostic laparoscopy, an excision of endometrial implants, and laparoscopically assisted vaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy for endometriosis and uterine fibroids. Should I bill separately for the excision of implants or is that included in the LAVH?

Massachusetts Subscriber

Answer: Billing separately for the excision of the implants will depend on their location in relation to the uterus and the amount of work involved. In this case, you would treat the endometrial implants as if they were adhesions, and if the physician performs significant work in removing them, you may be able to convince the payer to increase reimbursement.

Assuming you are billing for this service in 2003, you should code this by adding modifier -22 (Unusual procedural services) to the primary procedure. With CPT 2003, there are four LAVH codes: 58550 (Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 grams or less), 58552 ( with removal of tube[s] and/or ovary[s]), 58553 (Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 grams) and 58554 ( with removal of tube[s] and/or ovary[s]). You select the code based on the weight of the uterus and whether the tubes and ovaries have been removed, not by listing removal of the implants separately. (Please see the November 2002 Ob-Gyn Coding Alert for a complete discussion of these new codes.) Do not code them at all if the operative report does not show how significant the implant removal was.

The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.