Ob-Gyn Coding Alert

Question: Our ob-gyn scheduled the patient for the marsupialization of a Bartholin's gland cyst. The patient was put under anesthesia. The ob-gyn examined the cyst, and it had resolved to the  oint where it was too small to warrant doing a marsupialization. The ob-gyn discontinued the procedure. Should I report 56440 with modifier 53? Or should we bill an "exam under anesthesia?"

West Virginia Subscriber

Answer: In this case, you should report the procedure performed -- the exam under anesthesia (57410, Pelvic examination under anesthesia [other than local]) linked to 616.2 (Cyst of Bartholin's gland) as it better reflects the work performed by the physician. When you append modifier 53 (Reduced services), the payer will generally reduce the allowable for the procedure based on the documentation submitted that shows the amount of work performed. That reduction can be 10 percent or up to 50 percent of the allowable. However, in your case, the reduction would be closer to the 10 percent mark since he only examined the area. The relative value unit (RVU) for 56640 is 4.94, and the RVU for 57410 is 2.88. By doing the math, you can see that not only does 57410 correctly capture the work performed, but it would also likely yield the highest reimbursement.

ICD-10: When your diagnosis coding system changes in 2013, 616.2 will become N75.0 (Cyst of Bartholin's gland).