Oncology & Hematology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: The gynecologist performed a hysterectomy, but our gynecological oncologist completed the associated lymphadenectomy. What should I report for each physician? Should I use 38770 (Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes [separate procedure]) for the gynecological oncologist, and 58180 (Supra-cervical abdominal hysterectomy [subtotal hysterectomy], with or without removal of tube[s], with or without removal of ovary[s]) for the gynecologist? Illinois Subscriber

Answer: No, your code selection is incorrect. You've erroneously unbundled two codes. Many gynecologists and gynecological oncologists are unaware that the unbundled coding is improper because they've actually been paid that way.

To code correctly for the surgery: For each physician, report 58210 (Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling [biopsy], with or without removal of tube[s], with or without removal of ovary[s]) with modifier -62 (Two surgeons) to indicate that two surgeons were involved. If you add a third surgeon usually assisting the gynecologist you don't have a straightforward coding option. For example, to report the hysterectomy (58180) for both gynecologists using modifier -80 (Assistant surgeon) or -81 (Minimum assistant surgeon) for the assistant, and lymphadenectomy (38770) for the gynecological oncologist, would be incorrect. You should only code for two of the three physicians involved, leaving one without reimbursement. Usually, payment will short-change the assistant.

Coding rules change, however, if the gynecological oncologist becomes the lead surgeon during the procedure. This three-physician scenario may occur when the gynecologists, doing what they think is a routine hysterectomy, unexpectedly discover a carcinoma. If the gynecological oncologist becomes the lead surgeon after getting into the case, report this surgeon's services using the surgical procedure code and modifier -52 (Reduced services), indicating that this surgeon did not perform pre- and post-op care.

Using a single procedure code for many gynecological oncology procedures is appropriate, but without the proper modifier you won't get paid. So if the procedure submitted by the gynecologist has modifier -62, but the surgeon's report doesn't, whoever submits the bill first will receive payment.