Ob-Gyn Coding Alert

Question: I'm confused about when to use modifier -50. If a patient has ovarian cysts on both ovaries, and the ob-gyn either removes or drains both cysts during a surgical procedure, should I use modifier -50 to show that the ob-gyn performed the removal on both sides?

Kansas Subscriber

Answer: No, you should not use modifier -50 (Bilateral procedure). You will report 58800 (Drainage of ovarian cyst[s], unilateral or bilateral [separate procedure]; vaginal approach) or 58805 (... abdominal approach) depending on whether the cysts are on one or both ovaries (hence the language "unilateral or bilateral" in the code nomenclature). The same thing applies to the codes for ovarian biopsy (58900, Biopsy of ovary, unilateral or bilateral [separate procedure]) and removal of an ovarian cyst (58925, Ovarian cystectomy, unilateral or bilateral).
 
You should use modifier -50 in two situations: when the procedure in question has a unilateral descriptor, or when the ob-gyn operates on an organ pair and the code does not designate "unilateral or bilateral." For instance, the codes for fimbrioplasty, tubotubal anastomosis, tubouterine implantation and salpingostomy are unilateral-only codes, and if the physician documents surgery on both sides, you would apply modifier -50.
 
Even though the laparoscopic code 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) does not say "unilateral or bilateral," Medicare does not allow you to use modifier -50. The same thing applies to the laparoscopic approach for aspirating ovarian cysts (49322, Laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]) because while the code says "single or multiple," it does not say "unilateral or bilateral." Despite this guidance, Medicare says no to using -50 with this code either.