Ob-Gyn Coding Alert

Question: How should I you code correctly for a vaginal hysterectomy in which an anterior and posterior colporrhaphy was performed in the same session.

Sheila Young of Providence OB/GYN, RI

Answer: According to the CPT you use the 51 modifier. The CPT states: When Multiple procedures other than Evaluation and Management Services, are performed in the same day or at the same session by the same provider, the primary procedure or service may be reported as listed. The additional procedure(s) or services(s) may be identified by appending the modifier 51 to the additional procedure or service code(s) or by the use of the separate five digit modifier. Here are some tips on coding multiple procedures to help with your reimbursement:

1) List the major procedure with the largest RVU first. In this case the hysterectomy is the major procedure so it is listed first using the CPT code 58260.

2) List the next procedure and any others all along with the 51 modifier. Here you will use the 57260 (combined anteroposterior colporrhaphy) along with the 51 modifier.

3) List any addition procedures along with the 51 modifier.

Note: Check with your Medicare carrier regarding their current policy on the -51 modifier. Some carriers are requesting that use of the -51 modifier be discontinued.

Tip: Do not use the 51 modifier for add-on codes. Add-on codes in the CPT are additional or supplemental procedures that are identified by the use of specific descriptor nomenclature which includes phrases such as each additional or (list separately in addition to primary procedure). These codes are exempt from the multiple procedure concept.

Whether or not you are paid for the multiple procedure will depend upon the carrier and perhaps on how you list your charges for the procedure. According to Janet McDiarmid, CMM, CPC, and president of the American Academy of Procedural Coders, many carriers including Medicare will pay the first procedure at 100% and then reduce the subsequent procedures 50% or more. She suggests you bill your charge because Medicare carriers and other insurances will often automatically reduce the second procedure by 50%. So if you have already reduced it by 50% they may cut it again.

Tip: If you bill your full amount be sure that you explain this to the patient when the bill goes out. Patients may be concerned at the size of the bill even if they are not responsible for it.

If you find that you are rejected for multiple procedures look carefully at the explanation of benefits (commonly termed as the EOB) and if necessary request further explanation. You may need to send the surgical report or further explanation to qualify for reimbursement. Many payers may consider the multiple procedure to be part of the major procedure.