Wiki Hysterectomy Assist after C-Section

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marylee18

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Hello!

My physician was called in to assist with a hysterectomy for placenta previa after an emergency C-section when the OBGYN could not get the hemorrhage to stop bleeding. Uterus including cervix and both fallopian tubes were removed. The obvious code would be 59525, but he was not there for the C-Section so I cannot use it. I'm waiting for a call back from the OBGYN's office, but I'm assuming that will be the code they used.

Coding suggestions?
 
1
marylee18 said:
Hello!

My physician was called in to assist with a hysterectomy for placenta previa after an emergency C-section when the OBGYN could not get the hemorrhage to stop bleeding. Uterus including cervix and both fallopian tubes were removed. The obvious code would be 59525, but he was not there for the C-Section so I cannot use it. I'm waiting for a call back from the OBGYN's office, but I'm assuming that will be the code they used.

Coding suggestions?
Click to expand...
This is an interesting question. The idea that you must report this add-on code with the cesarean should only apply to the primary surgeon, not the assistant. Therefore, I see no reason why you cannot submit 59525-80 for the part your physician played.
 
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Yes, it will go to claim edits - can you force it out? Otherwise you could also use an abdominal code. Either way, you will likely have to appeal with explanation and notes.
 
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The code instructions for 59525 are "Subtotal or total hysterectomy after cesarean delivery (List separately in addition to code for primary procedure)." So, if you're using 59525 you must include the appropriate "primary procedure" code which would be the C-section. Yes, he was not there for the C-section, but the medical necessity for the 59525 was the C-section, from what I am reading in your post.
 
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I agree. I would use 59525-80 since that is what the primary will be reporting anyway. IF the claim were denied, I would submit an letter of explanation.
I think perhaps once many, many years ago we had this situation and that was my conclusion at the time.
 
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Hello,
I have a following question please, and I will greatly appreciate your help. Thank you.
When we billed +59525 for the MD who did Only hysterectomy, the charge went to edits asking for a prim code but the MD was not present during c-s delivery, so we cannot use the prim CPT. Can we use 58150-52- abdominal hysterectomy?
 
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natashalage said:
Hello,
I have a following question please, and I will greatly appreciate your help. Thank you.
When we billed +59525 for the MD who did Only hysterectomy, the charge went to edits asking for a prim code but the MD was not present during c-s delivery, so we cannot use the prim CPT. Can we use 58150-52- abdominal hysterectomy?
Click to expand...
This code is to be used by the physician who did the cesarean, not another physician who did not. In that case the one who does the hysterectomy independently bills an abdominal hysterectomy code with the modifier -52 (because the abdomen was already open and the uterus exposed).
 
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I had the same situation I billed the csection only code with modifier 80 and a fee of .01 or zero if the system you use allows it and then the add on code 59525 modifier 80 . You have to put the modifier 80 on the csection because if not they will pay the penny and consider your provider as the primary surgeon
 
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