Wiki 58545 w/morcellation

[Korbc]

Does anyone know if morcellation that took an extra half hour with a scalpel can be separately coded or is that inclusive to this code or should I append a modifier 22? I think 22 because I don't believe there is a code for morcellation and it would be considered an unlisted procedure if it did ever need to be coded.....?

 

[csperoni]

There is no code separate code for morcellation as it is simply cutting up the specimen in order to fit through the tiny laparoscopic port incisions. It is part of perfoming the surgery just like inserting the ports, ligating arteries, and closing the incisions. I would also want to confirm morcellation. It used to be common in laparoscopic procedures, but is a bit rare now. Some physicians do morcellation, but in a different method than prior. Currently place the specimen in a specific bag, exteriorize the opening of the bag, then cut the specimen keeping it 100% contained in the bag. Previously morcellation was done of the specimen internally, which could potentially allow for undiagnosed cancer cells to spread throughout the abdomen.
Getting back to your actual question, you need to decide whether 30 additional minutes qualifies to justify -22. I have never seen an "official" guideline on this. Some use it only at 60 minutes. Others 45. Others 30. I try to think of it more about a percentage of additional time. If the average 58545 takes 6 hours, then for an extra 30 minutes I would not use -22. If the average 58545 takes 45 minutes, then an extra 30 minutes would justify (IMHO) -22.
I would also think IN GENERAL if the fibroids are few and small, that it would not USUALLY take 30 minutes of morcellation. Is it possible there were actually 5+ myomas or > 250 grams in total? If so, look at 58546 which is already higher valued because more/larger fibroids will take more work.

 

[Korbc]

There is no code separate code for morcellation as it is simply cutting up the specimen in order to fit through the tiny laparoscopic port incisions. It is part of perfoming the surgery just like inserting the ports, ligating arteries, and closing the incisions. I would also want to confirm morcellation. It used to be common in laparoscopic procedures, but is a bit rare now. Some physicians do morcellation, but in a different method than prior. Currently place the specimen in a specific bag, exteriorize the opening of the bag, then cut the specimen keeping it 100% contained in the bag. Previously morcellation was done of the specimen internally, which could potentially allow for undiagnosed cancer cells to spread throughout the abdomen.
Getting back to your actual question, you need to decide whether 30 additional minutes qualifies to justify -22. I have never seen an "official" guideline on this. Some use it only at 60 minutes. Others 45. Others 30. I try to think of it more about a percentage of additional time. If the average 58545 takes 6 hours, then for an extra 30 minutes I would not use -22. If the average 58545 takes 45 minutes, then an extra 30 minutes would justify (IMHO) -22.
I would also think IN GENERAL if the fibroids are few and small, that it would not USUALLY take 30 minutes of morcellation. Is it possible there were actually 5+ myomas or > 250 grams in total? If so, look at 58546 which is already higher valued because more/larger fibroids will take more work.

thank you so much! she mentioned in the op report using the bag and in a private message says she thinks the 12cm fibroid is over 250 grams which just waiting on pathology now at this point. Thanks again csperoni!!