Ob-Gyn Coding Alert

You Be the Coder:

Surgery by Two Physicians

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: Our physician and a physician from another office performed surgery on the same day. The other physician opened the patient up and did part of the surgery, and then our physician did a hysterectomy and had one of our physicians assist him. Then the other physician finished his surgery and closed the patient up. Our physician is thinking he should code the hysterectomy with a -54 modifier (surgical care only). Is this correct? Keep in mind the other physicians surgery was a three-hour surgery.

Shelly Bunting, Insurance Manager
LowCountry Womens Specialists
North Charleston, S.C.

Answer: Correct billing for surgery when more than one physician is involved can be complicated, but knowing what the whole surgery entailed may help to direct you to the correct answer in this case. First, while you say that your physician performed a hysterectomy after the first surgeon performed his part, is there a code in CPT that describes what the two physicians together accomplished? If so, both surgeons would bill the same surgical procedure code and both physicians would add a modifier -62 (two surgeons) to that code.

In other words, they would have been acting as co-surgeons and, in that case, who opened or closed will not matter. Both physicians probably will be following up with the patient for their respective services.

Likely codes when an abdominal hysterectomy would be part of the procedure include 58152 (hysterectomy with MMK/Burch), 58200, 58210 or 58951 (hysterectomy with lymph node sampling or lymphadenectomy). If the other surgeon did not perform any of these procedures but did something else entirely, both surgeons will bill for what they did independently. Your physician, however, will need to add a modifier -52 (reduced services) to the abdominal hysterectomy code 58150. This is because he did not open or close and probably also did not provide any postoperative care if he was simply called in to do the procedure.

The modifier -54 generally is reserved for those instances when one physician performs a single surgery and another physician who was not involved in the surgery will be providing the pre- and postoperative care. By the way, given that there was already a surgeon present when the hysterectomy was performed, it is unlikely that a payer will reimburse for a third physician to assist only with the hysterectomy in this case. Be prepared to show medical necessity.