Ob-Gyn Coding Alert

Question: We have found some conflicting information on 58661 and being able to use modifier 50. Medicare shows it as a unilateral procedure, I know. In CPT^®, it shows as bilateral. Most of our surgeries involve commercial payers. Does modifier 50 need to be appended for bilateral procedures other than Medicare?

Texas Subscriber

Answer: You should append modifier 50 (Bilateral procedure) irrespective of the payer unless you know for sure that your payer is using the CPT^® rather than the Medicare definition for code 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy).

Because many commercials apply Medicare modifier definitions, modifier 50 has a good chance of being reimbursed. In the worst case, they only pay you for one side at 100%, but in the best case, they pay you 150%. You should know that initially (in 2002) CPT^® said this was a unilateral procedure, and Medicare said it was bilateral; then the reverse was announced in 2010.