Ob-Gyn Coding Alert

Question: Why is 58605, postpartum tubal, listed as a separate procedure? Is it supposed to be part of a vaginal delivery? Even with modifier 59, I have to appeal every claim documenting a different trip to the surgical suite, unrelated to the delivery in a labor and delivery room.

Texas Subscriber
 
Answer: Your best bet is to add modifier 79 (Unrelated procedure by the same physician during the postoperative period), not 59 (Distinct procedural service) to 58605 (Ligation or transaction of fallopian tube[s], abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization [separate procedure]).
 
CPT has never explained why this code is a -separate procedure,- but it might have inferred that sometimes an ob-gyn performs the procedure on the same date as the delivery (which is rarely the case). CPT does, however, indicate in the August 2002 CPT Assistant that you should bill this code in addition to the delivery code. 
 
Bottom line: If the ob-gyn does the tubal on the day of delivery, continue to use modifier 59. If the ob-gyn performs the tubal on the next day or later while the patient is still in the hospital for the delivery, use modifier 79.