Ob-Gyn Coding Alert

Question: My ob-gyn aspirated and biopsied an ovarian cyst laparoscopically. I received a denial when I bill 49321 and 49322 together. Is there a reason?

Nevada Subscriber

Answer: If the ob-gyn performs these procedures on different cysts -- as in, biopsying one and aspirating the other -- you can bill both codes.

Remember, not all payers follow Correct Coding Initiative (CCI) edits, so they may bundle these codes. If the payer is denying the claim as "incidental" or "bundled," then try adding modifier 59 (Distinct proced ural service) to 49321. Alternatively, if the biopsy was on the left side and the aspiration on the right, use modifiers LT (Left side) and RT (Right side). If your ob-gyn is performing 49321 (Laparoscopy, surgical; with biopsy [single or multiple]) and 49322 (... with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]) on the same cyst, then you can report only one of these codes -- not both. You should report the higher paying code, which is 49322.