Ob-Gyn Coding Alert

Question: How should I report a total abdominal hysterectomy, salpingo-oophorectomy and enterocele repair during the same operative session?

South Dakota Subscriber

Answer: A total abdominal hysterectomy occasionally includes an enterocele repair when the patient does not have one, and the ob-gyn places the sutures to prevent one from forming. If this is the case, you should report 58150 (Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]).

If the surgeon has documented an enterocele (618.6, Vaginal enterocele, congenital or acquired), you should report the repair as 57270 (Repair of enterocele, abdominal approach [separate procedure]) with modifier -59 (Distinct procedural service) appended in case the payer bundles the code. Some payers may also require a modifier -51 (Multiple procedures) on the second procedure code. You should note that the National Correct Coding Initiative (NCCI) does not bundle these codes.