Ob-Gyn Coding Alert

Question: How would you code laparoscopy with right ovarian cystectomy and fulguration of endometrial implants? Code 56304 is for the fulguration, but a separate procedure. Would you bill it 56303 and 56304-59? Or just 56303?

Anonymous NJ Subscriber

Answer: First we need to define the procedures performed and then the correct codes can be selected. In the coding case this month (see page 52), we discussed how to bill for a laparoscopic ovarian cystectomy (reporting 56303, laparoscopy, diagnostic; with fulguration of excision).

Unfortunately, this code also is used to report the fulguration of endometrial implants. In this case, if the physician has documented significant additional work, a modifier -22 (unusual procedural services) can be added to code 56303. Documentation should accompany the claim explaining the additional work, however. Code 56304, on the other hand, is used to report lysis of adhesions, a procedure that this physician did not apparently perform. As you point out, this code is a CPT separate procedure which means it will normally be considered an integral part of the primary procedure unless the documentation clearly identifies it as distinct under CPT guidelines (see pages 48-49 in CPT 1999). If the documentation had described lysis of adhesions and the procedure was documented as distinct from the ovarian cystectomy, the code 56304 could be reported in addition. Both a modifier -59 (distinct procedural service) and a modifier -51 (multiple procedures) would need to be added to this code.