Ob-Gyn Coding Alert

Question: My ob-gyn did a paratubal cyst excision when done at the time of a c-section. I know to use 4920X based on size, but should I use modifier 52 because the surgeon is already in the abdomen?

South Carolina Subscriber

Answer: The answer depends on who performed what service.

Same physician: You should not apply modifier 52 (Reduced services) to 4920X (Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; ...). If the same surgeon who did the delivery did the paratubal cyst excision, then you should treat this as a multiple procedure (as in, modifier 51, Multiple procedures).

Different physician: However, if a second surgeon did the paratubal cyst excision at the time of the c-section, then you should apply modifier 52 to 4920X.