Ob-Gyn Coding Alert

Question: I need a CPT^® code for vaginal cuff repair. The patient had a total abdominal hysterectomy (TAH) with lysis of adhesions (LOA). She presented to the ER with pain and watery discharge after having sexual intercourse. The ob-gyn used a diagnostic laparoscopy to probe the area. The vaginal cuff was sutured in interrupted fashion. What should I report?

California Subscriber

Answer: You have not indicated if the vaginal cuff was sutured via the laparoscope or from below so an exact coding solution is not possible.

However, you do know that a diagnostic laparoscopy was performed, so your primary procedure will be 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)).

If the ob-gyn sutured the cuff from above, you should not bill for any additional procedures. Unless there was significant additional work involved in doing this suturing, you should append a modifier 22 (Increased Procedural Services).

If the suturing was done from below, you might consider adding 58999 (Unlisted procedure, female genital system (nonobstetrical)), but you will have to find a good comparison code to let the payer know the extent of this additional work. If you refer to the Ob-gyn Coding Alert, volume 24, number 6 article entitled, “Declare Victory Over Vaginal Cuff Repair Claims by Answering 3 FAQs,” you will find some great tips on billing.

Don’t forget: Because this appears to have taken place in the global period of the original surgery, you should append a modifier 78 (Unplanned Return to the Operating/Procedure Room…) to these codes.