Wiki Exploratory Laparotomy

[Girlzsmom66]

Dr performing an exploratory laparotomy, 49000 with LSO, possible BSO with staging, possible ovarian cystectomy

I certainly don't want to use anything from the 58940-58960 range. Do I?

However, would it be appropriate to use the 58925?

Here is how the MD is ordering:

Will plan for an Xlap, probable RSO, possible LSO vs ovarian
cystectomies, possible staging (omentectomy, lymph node dissection, biopsies).

Any and all assistance is greatly appreciated.

Also, when obtaining prior authorization, I was taught to get authorization for possibles and probables.

Thank you so much!!!!

 

[csperoni]

I know this is late, but since no one else responded, I'll jump in.
Regarding "possibles":
- We always communicate that information to hospital booking office so that appropriate consent/surgery times/equipment/staff will be available if the possible is actually done.
- We never precert for possibles. We do for probables. I would precert this 58720.
- Actual coding and billing is done after the surgery actually takes place (and sometimes even after pathology is available). I recall communicating with another office once for a surgery we assisted on and when she provided the billing codes, I explained that could not possibly be the correct combination of codes. Her response was "well, that's what we pre-certed for". It gave me nightmares.

In my almost 14 years of coding for gyn onc where there are always possibles beforehand, maybe 5 times I ever had an issue about getting paid when we did a more complex surgery than pre-certed.