Ob-Gyn Coding Alert

Total abdominal hysterectomy (58150) is a common gynecological surgery that requires postsurgical follow-up. For complications following surgery, coders need to know when to use modifiers, which modifiers to use, and which payers will reimburse for postoperative procedures within the global period.

Contacting individual payers before submitting obstetric and gynecological surgical package claims (56405-59899) will help you sort out the appropriate CPT or Medicare definition to use for a global period. It is particularly important that you determine early on what your payers guidelines are on the lengths of postoperative services because CPT and Medicare definitions for surgical packages differ markedly.

Also, third-party payers may have their own guidelines regarding what constitutes an appropriate length of time for the global period or follow-up for surgical services and procedures. The global period for major surgeries can range from 21 days to as much as 90 days of follow-up for the same procedure.

Coding Within the Global Period

If the postoperative procedure or service does not fall within the global period, the ob/gyn is entitled to independently claim reimbursement under both CPT and Medicare guidelines. But with hysterectomies, most complications occur within the first 10 days following surgery, and 58150 (total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or withoutremoval of ovary[s]) has a 90-day global period. For procedures occurring within the global period, an in-office procedure may be considered a normal complication of the initial surgery.

For example, a patient with a wound infection a complication of the hysterectomy returns to see the ob/gyn within the global period and is treated during the office visit. The E/M visit to treat the infection may be considered part of the surgical global package and any procedure that might be performed (e.g., wound cleaning or repacking) treated as a normal complication of surgery. While a few carriers will pay for this visit as an E/M charge, Medicare and the majority of private carriers will not consider this a billable service.

A lot of physicians dont pursue charges like these because they consider them part of taking care of the operation, says Philip Eskew Jr., MD, medical director of women and infant services at St. Vincent Hospital in Indianapolis. Eskew adds that a postoperative wound infection generally doesnt require a lot of physician time to treat. However, Eskew contends that if complications are significant and require a return to surgery or other more involved procedures, it is appropriate to seek reimbursement.

Know the Global Ground Rules

Both Medicare and CPT have criteria for what is included in the surgical package. CPT says the surgical package includes only the following elements:

The surgical procedure

Local or topical anesthetic or metacarpal [...]