Ob-Gyn Coding Alert

Question: Our ob-gyn worked with a gynecologic oncologist to perform a radical abdominal hysterectomy and a combined anteroposterior colporrhaphy with enterocele repair. How should I report this to Medicare?

Ohio Subscriber

 Answer: Medicare may allow you to bill co-surgery for 58210 (Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling [biopsy], with or without removal of tube[s], with or without removal of ovary[s]) if the procedure required the skills of both surgeons and if the physicians were of different specialties. In fact, Medicare recognizes gynecologic oncology as a separate specialty from ob-gyn practitioners. So each doctor would report the co-surgery for the hysterectomy as 58210-62 (Two surgeons).
 
The same co-surgery requirements apply to the colporrhaphy with enterocele repair (57265, Combined anteroposterior colporrhaphy; with enterocele repair). But the oncologist likely would not be performing his or her own portion for this procedure or assisting with it. If your physician performed this surgery on his or her own, you would report 57265 appended with modifier -51 (Multiple procedures), and the oncologist would not report any services for the colporrhaphy.