Ob-Gyn Coding Alert

Question: When the doctor performs a D&C and removes an endocervical polyp at the same time he performs a laparoscopy tubal sterilization should we use modifier -51 or modifier -59? We have the same questions with a TAH at the same time as an A&P repair.

Nicolas Marino, MD
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Answer: Deciding when to use the -51 or -59 modifier has been confusing coders since the -59 modifier was introduced in 1997. The modifier -59 should be added to CPT codes that are designated as separate procedure. This means that under normal circumstances the separate procedure is an integral part of the main procedure, but you would only be reporting it with the -59 modifier to show that this time it is a distinct procedure. This modifier is also considered the modifier of last resort and as such should be used sparingly. The code 58120, D&C, and codes 56301/56302, which describe laparoscopic tubal ligation are not CPT separate procedures so the -59 modifier would be incorrect to use. Instead, append a modifier -51 to each procedure and be sure to list why each procedure was performed via the ICD-9 diagnosis code(s).

The same statement applies to the TAH with A&P repair. Neither of the CPT codes that describe these procedures is a CPT separate procedure, therefore the modifier -59 would not be added to either code.