Ob-Gyn Coding Alert

Did you report combo code 58152 rather than 51840?
Got your answers handy? Check them against what our experts say.

Answer 1: You should report only 58150 (Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]). In general you should not separately code for a biopsy when the ob-gyn removes the area of the biopsy. 
 
Despite this not being a National Correct Coding Initiative edit, most payers will deny a cervical biopsy (57500, Biopsy, single or multiple, or local excision of lesion, with or without fulguration [separate procedure]) when the ob-gyn performs one at the time of a TAH. The one exception might be if the ob-gyn needed to perform the biopsy prior to determining if the patient needed a TAH/BSO. In that case, you may want to add modifier 59 (Distinct procedural service) to 57500.

Answer 2: Your coding for this scenario will depend on whether the ob-gyn documented that the patient has an enterocele or whether this repair was prophylactic in nature (not payable). Because the physician performed a TVH without removing the tubes and ovaries, you have two coding choices. As long as your ob-gyn documents an enterocele to repair, you would use 58270 (Vaginal hysterectomy, for uterus 250 grams or less; with repair of enterocele) or 58294 (Vaginal hysterectomy, for uterus greater than 250 grams; with repair of enterocele), says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.

Answer 3: You should use the combination code 58152 (Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]; with colpo-urethrocystopexy [e.g., Marshall-Marchetti-Krantz, Burch]). If you were to report 58150 and 51840 (Anterior vesicourethropexy, or urethropexy [e.g., Marshall-Marchetti-Krantz, Burch]; simple), most payers would think you-ve unbundled the parts of the combination code.

Answer 4: Many payers will deny the vaginal vault suspension for lack of medical necessity. The American College of Obstetricians and Gynecologists states that in the case of total or subtotal abdominal hysterectomies, -repairs or suspension procedure of vagina, urethra and perineum- are -examples of intraoperative services excluded from the global service.- Payers argue, however, that the suspension procedure is preventive rather than restorative at the time of the hysterectomy because the ob-gyn performs it to prevent the prolapse from happening in the future.

Generally, you can report the suspension if the payer doesn't bundle it into another procedure for which you-re coding. For instance, Medicare includes 57280 (Colpopexy, abdominal approach) with 58150. You cannot bypass this edit. Medicare, however, does not bundle any of the vaginal approach colpopexy codes (such as 57282, Colpopexy, vaginal; extra-peritoneal approach [sacrospinous, iliococcygeus]) into abdominal hysterectomy codes.
 
-The vaginal vault suspension code is dependent upon the approach the ob-gyn performed,- says Amy M. Mannor, RN, BBA, a physician compliance nurse auditor at Bronson Healthcare Group in Kalamazoo, Mich. For instance, if the ob-gyn performed an abdominal approach colpopexy for a documented vaginal vault prolapse prior to the surgery, you can add modifier 22 (Unusual procedural services) to 58150 when billing Medicare

For non-Medicare payers that do not follow NCCI edits, you should report the suspension procedure in addition to the hysterectomy. Append modifier 51 (Multiple procedures) to the vaginal vault suspension code.

Answer 5: You have only two options when coding for a laparoscopic supracervical hysterectomy. You can either use the existing LAVH codes (58550-58554) with modifier 52 (Reduced services) to denote a reduced service because the ob-gyn didn't remove the cervix, or report the unlisted laparoscopy code (58578, Unlisted laparoscopy procedure, uterus).

-Personally I prefer the unlisted-procedure code. Most insurance companies already have fee schedule amounts established for this procedure, so this is the most direct coding option,- Callaway says.

Note: CPT rules state very clearly that you may not report a laparoscopic procedure using an abdominal approach code (such as 58180, Supracervical abdominal hysterectomy [subtotal hysterectomy], with or without removal of tube[s], with or without removal of ovary[s]).

Answer 6: You can report the total abdominal hysterectomy using 58200 (Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube[s], with or without removal of ovary[s]) and the partial vulvectomy using 56620 (Vulvectomy simple; partial).

Keep in mind: -In this example, the vulvectomy performed in the post-op period is not a re-operation or treatment for a surgical complication,- says Mary Mulholland, RN, BSN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia. -Both surgical procedures are clearly unrelated to one another. To report these distinct procedures accurately and to receive appropriate reimbursement, you should append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to 56620.-

Although the patient only had 25 days left in the original global period, using modifier 79 on the claim will launch a new global period for an additional 90 days.

Answer 7: This procedure description means that the surgeon performed a vaginal hysterectomy with anterior and posterior (A&P) rectocele repair. The coding is 57260 (Combined anteroposterior colporrhaphy) for the A&P repair, 58260 (Vaginal hysterectomy, for uterus 250 grams or less) and 58262 (... with removal of tube[s], and/or ovary[s]) for a uterus 250 grams or less. A larger-size uterus means you-ll use 58290-58291 instead. Keep in mind that some payers will try to deny the A&P repair, so make sure you have supporting diagnoses for this procedure.