Ob-Gyn Coding Alert

Modifier -59 is for procedures you would not normally report together When a patient requires a hysterectomy and a separate abdominal repair in the same session, do you report only one code? If the ob-gyn performs an ultrasound and a biophysical profile, do you automatically assume you can't report the profile? If you answered "yes" to either of these questions, you may not be taking advantage of all situations in which you can use modifiers -59 and -51. Read on for more information on these modifiers, which may be helpful when you report related codes on the same claim. Modifier -59 Applies When Codes Are Close Ob-gyn coders use modifier -59 (Distinct procedural service) to identify procedures that are distinctly separate from any other procedure or service the physician provides on the same date. In general, you should append modifier -59 to procedure codes when the physician:
  sees a patient during a different session treats a different site or organ system sees a patient during a different encounter treats a different organ system treats a separate injury.   Modifier -59 is "used when multiple procedures in the same (code areas) are performed at the same time," says Linda Parks, MA, CPC, CMC, CCP, coding specialist in Marietta, Ga.

Example: Let's take the scenario mentioned earlier, in which the physician performs a hysterectomy and separate abdominal repair in the same session. A 35-year-old patient reports to the office with uterine fibroids and a symptomatic enterocele. The ob-gyn performs a complete abdominal hysterectomy and makes a repair to the enterocele via abdominal approach. You should:   report 58150 (Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]) for the hysterectomy. report 57270 (Repair of enterocele, abdominal approach [separate procedure]) with modifier -59 attached. The modifier shows the carrier that the hysterectomy and abdominal repair were separate procedures.   Remember: The higher the relative value units (RVUs) for a given code, the more you'll be paid for the procedure. Always attach modifier -59 to the code with the lower RVUs.

Payoff: The RVUs for 58150 (hysterectomy) are 24.63 for facilities, while 57270 (abdominal repair) is worth 19.78 for facilities. Note: Neither 58150 nor 57270 has nonfacility RVU totals. Not Sure? Check NCCI If you're stuck on whether you should bill codes with modifier -59, check the National Correct Coding Initiative (NCCI) edits, Parks says. If the codes you are reporting have indicators of "1" next to them, this means you can append the modifier to bypass the edit. If the code has an indicator of "0," you cannot bypass the edit. The NCCI [...]