Wiki ob/gyn coders

[Jamie Dezenzo]

Hello all,

Right fallopian tube was carried out to fimbriated end and the Falope ring applicator was passed through the 8 mm port and a Falope ring was successfully placed on the right fallopian tube at the mid-isthmic portion of the tube. Adequate knuckle of tube was obtained within the Falope ring. Images were taken. The Falope ring applicator was then reloaded and placement of the Falope ring applicator was attempted on the left fallopian tube 2 separate occasions without adequate release of the Falope ring itself and in the process, the left fallopian tube was transection and there was some oozing noted from the tube; therefore, incision was made to cauterize this side with the Kleppinger cautery. The Falope ring applicator was removed. The Kleppinger cautery was passed through the 8 mm port and approximately 3 cm to 4 cm of left fallopian tube was cauterized using the Kleppinger. Hemostasis was noted. Kleppinger was removed.

This is a Medicaid patient 58670/58671 mut exclusive.....thoughts on billing....58671 only or 58670 RT 58671 LT????

Thanks
Jamie

 

[nsteinhauser]

Been there, done that. In a perfect world, CPT should update the codes and RVU's so that we should be able to use -RT and -LT on these. Situations like this don't happen frequently, but they happen. When I tried submitting this previously with attached op notes, using the -rt and -lt, the payer rejected the "incorrect modifiers" and denied the second (fulguration) line because of the mutually exclusive edit. So they ended up paying the 58671 and denying the 58670. Per 2013 CPT, the -52 modifier is now under the 'approved for ASC use' category, so you could use both and modify them but the 58670 may still get denied. Coding the 58671 alone seems to be the easiest answer but it's not correct. Sorry - no help here.

 

[Jamie Dezenzo]

Thanks and will go with the 52 modifier!