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MsGarner69

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A 30 year old disabled Medicare patient is scheduled for surgery due to the discovery of what looks like an ovarian mass on the right ovary. On entering the abdomen, the surgeon finds an enlarged ovarian cyst on the right, but the ovary is otherwise normal. The left ovary is necrotic looking. The decision is made, based on the patient's age, to remove the cyst from the right ovary and to remove the entire left ovary and fallopian tube.

Answer is
58925, 58720-59

My question is why wouldn't the Salpingo-oophorectomy be listed as the first procedure since it's the most complex?
 
The cystectomy RVUs are slightly higher than the SO RVUs. Maybe it takes slightly more work to remove a cyst from the ovary than it does to remove the entire ovary. That's just a guess, though. I also am not getting any CCI bundling edits on these 2 codes, so technically a 59 modifier shouldn't be needed. I'd code that one as 58925-RT, 58720-LT to separate out the one from the other.

Becky Hardin, CPC
 
bonzaibex said:
The cystectomy RVUs are slightly higher than the SO RVUs. Maybe it takes slightly more work to remove a cyst from the ovary than it does to remove the entire ovary. That's just a guess, though. I also am not getting any CCI bundling edits on these 2 codes, so technically a 59 modifier shouldn't be needed. I'd code that one as 58925-RT, 58720-LT to separate out the one from the other.

Becky Hardin, CPC
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Hello Becky,

Well the scenario came from the AAPC study guide. I agreed with the usage of modifier 59. I just didn't understand how a cyst removal would be considered more complex then actual body organ removal. So do we always have to check CCI edits to determine if a modifier is necessary? I was under the assumption that as long as you have two distinct procedures then one would be necessary all the time. I'm also curious why LT/RT modifiers weren't needed? :confused:
 
I use LT/RT modifiers instead of -59 when I feel it might get me less flak from the insurance carrier. They basically do the same thing as a -59 by indicating different body parts. I do check CCI edits routinely for bundling issues. If a -59 is allowable, I then have to make sure it's appropriate. A lot of my providers want me to bill with a -59 without understanding the purpose. They just want to get the most out of the surgery, no matter what. So I have to make sure the code I'm using a -59 on meets the requirements.

I can see how a cyst removal can be more complex than an organ removal. I imagine it might take more finesse to remove it without damaging the surrounding tissue than it does to remove the entire organ. I could be wrong, but that's how I think of it.

(I apologize for the delay in my response. I didn't see your follow up question until today.)

Becky
 
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