Wiki ectopic with requested tubal sterilization

[ljhaley@gmail.com]

PROB: female with a ruptured right ectopic pregnancy, requesting permanent sterilization vial a tubal ligation to the left side at time of surgery for the ectopic problem.
PROC Performed: Laproscopy, with right salpingectomy, a left tubal ligation, and evacuation of 1000ml of hemoperitoneum.

We billed as 59151, with add on code of 58611, attached no modifiers as directed by CCI and checked to be sure neither code excluded the other.

Today the payor's EOB says they're paying the 59151 only, denying 58611 as inclusive
(My supervisor put ICD9 of 761.4 on both, but maybe the 58611 should've been V61.5?)

Called the payor, all they said was "wrong codes" nothing more specific-can anyone give me some suggestions please? MANY thanks!

 

[bonzaibex]

59151 is a laparoscopic tx code. 58611 is for tubal done at the time of cesarean or other intra-abdominal surgery. If the tubal ligation was also done laparoscopically, look at 58670/58671.

Becky, CPC

 

[ljhaley@gmail.com]

Thank you for your reply! We actually had that exact code out today when reviewing the notes again, and thought it was probably the one! Always feels good to know you're on the right path! We also changed the dianosis code on the tubal to reflect multiparity, which should also help! Greatly appreciate the response! Linda