Ob-Gyn Coding Alert

Question: What should we do for hysterectomy coding in a case of double reproductive organs? The procedure is an open total abdominal hysterectomy with salpingo-oophorectomy done twice. I have not encountered any information for a double hysterectomy. I don't think insurance carriers will pay for 58150 x 2 units or 58150 and 58150-59 unless their policy says so. I could not even find any policies pertaining to such case. My suggestion is to bill modifier 22 and submit the claim along with the explanation letter and operative report. I have thoroughly reviewed provider's report and clearly indicated the patient's condition, specified the anatomy and include the following statements:

1. I took extra time to identify the vaginal cuff due to adhesions on the bowel to the portion of vagina.
2. Identifying vaginal fornices was difficult to due to anterior cuff not being connected to the cervix.
3. Extra time was used to perform dissection and removal of specimens.
4. Overall time has doubled due to lysis of adhesions, posterior cul-de-sac and extra dissection due to uterine and vaginal anomalies.

What should I do?

Texas Subscriber

Answer: You should code this with 58150 (Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s)) using a modifier 22 (Increased procedural service), as using units will get an automatic denial. You do want this one to go to review. Sounds like you have grounds, but make sure the surgeon also specifies the time if took over and above a normal hysterectomy.