Ob-Gyn Coding Alert

Question: What would be the most comparable CPT^® code to the LUNA (Laparoscopic uterosacral nerve ablation) unlisted procedure?

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Answer: Your unlisted code will be 49329 (Unlisted laparoscopy procedure, abdomen, peritoneum and omentum).

Reference: You will find an Ob-gyn Coding Alert article that addresses this from 2010 (Issue 13n7). The excerpt that deals with pricing is as follows:

You should use two codes to make a comparison for this procedure: 58400 (Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine ligaments; [separate procedure]) and 58410 (... with presacral sympathectomy).

Why: A presacral sympathectomy involves removing or destroying a part of the presacral nerve to alleviate pain, which is very similar to performing this on the uterosacral nerve. But in most cases, when done laparoscopically, there is no accompanying uterine suspension. Since 58410 includes both a uterine suspension and the nerve disruption, you will need to compare the LUNA to 58410, but representing less work.

To calculate how much less work, you would need to subtract the total relative value units (RVUs) for 58400 (12.52) from those for 58410 (22.93) to come up with an approximation. The resulting RVUs (10.41) can then be compared to a listed laparoscopic code. In this case, 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]) with 10.67 RVUs comes the closest. At that point your physician would need to decide if the work involved was more or less than a laparoscopic aspiration and set the requested reimbursement accordingly.