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Ob-Gyn Coding Alert

Reader Questions:

Unrelated Procedures Not Getting Paid? Check Your Policy

Published on Mon Nov 21, 2011

Question: Blue Cross Blue Shield (BCBS) is denying our claim for a laparoscopic tubal ligation (58670). However, the physician also aspirated an ovarian cyst, so I added 49322. BCBS says these codes are mutually exclusive. Can we get paid for the aspiration of the cyst? North Carolina Subscriber Answer: Their denial seems incorrect. Codes 58670 (Laparoscopy, surgical; with fulguration of oviducts [with or without transection]) and 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]) are unrelated procedures. You should not consider one incidental to the other. Maybe you need to add modifier 59 (Distinct procedural service) to 49322 to conform to BCBS rules. If this doesn't succeed, the insurer may have a policy of paying only one procedure per surgery, and bundling everything else. Best advice: Check with the insurer's policy. -- The answers for Reader Questions and You Be the Coder provided by [...]
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