Ob-Gyn Coding Alert

Question: A physician did a diagnostic laparascopy with removal of ovarian remnant and lysis of abdominal and pelvic adhesions. I want to bill for 56307 (using the 1999 CPT code) or 58611 (removal of adnexal structures) with the ICD-9 code for ovarian remnant, but there is no such code that I can find. My question is, how should I code for ovarian remnant?

Rogene Jochimsen
Harbin Clinic, Rome, Ga.

Answer: The ICD-9 manual includes diagnostic codes for illness, disease, symptoms, conditions and other reasons for encountering the healthcare system. Unfortunately, the existence of an ovarian remnant by itself does not fall into one of these categories. Instead, ask the physician why the ovarian remnant posed a problem for this patient. If the patient had been complaining of pain (625.9) prior to surgery and in the absence of prior knowledge of the ovarian remnant, this probably would be your best indication for the surgery to remove the remnant. You of course will link the adhesiolysis code to pelvic adhesions (614.6).

Remember also that the adhesiolysis code may be denied at first submission if you do not add modifier -59 to the code to indicate it was a distinct procedural service. This is because lysing of adhesions is considered by most payers to be an incidental procedure unless the documentation shows significant work in removing then (i.e., more than just blunt dissection of adhesions). Many times, you will have better luck in getting paid additionally for the adhesiolysis by adding a modifier -22 (unusual procedural services) to the primary procedure and sending in the documentation with the claim.