Wiki Assistant surgeon for hysterectomy after cesarean

[smstearns]

Dr. A did a cesarean and then a hysterectomy, same incision. Dr. B, a resident, assisted with the c-section. Dr. C (different practice) was called in to assist with only the hysterectomy. What is the correct way to bill for Dr. C? Thanks in advance.

 

[csperoni]

I see 3 options and all are likely to be denied first submission.
1) 58150 with applicable assistant modifier (80/81/82/AS) which is NOT my recommendation
2) 58150-52 and applicable assistant modifier (80/81/82/AS) also NOT my recommendation
3) 59525 with applicable assistant modifier (80/81/82/AS) which IS my recommendation
59525 best describes the work that was performed. The issue is that 59525 is an add on code, and the surgical assist did not perform any of the primary codes.
I recommend billing 59525 with assistant modifier to match the primary surgeon codes. When denied, submit a simple appeal letter explaining.
I've never needed to bill for an assist on only the hysterectomy, but have had occasion to bill for a different physician/subspecialist performing the hysterectomy after another physician delivered which is recommended as 58150-52 for the primary surgeon.

https://www.aapc.com/codes/coding-newsletters/my-ob-gyn-coding-alert/reader-questions-different-mds-for-c-section-and-hysterectomy-do-this-169875-article

PS - don't forget since this seems to be a teaching hospital with obgyn residents, documentation must support there was no qualified resident available and the work Dr. C performed.

 

[smstearns]

Thanks so much for your help on this!