Wiki OB Procedures

[mslori7]

Hi,

I have another scenario in which the physician performed a laparascopic lysis of adhesions, left salpingectomy, right ovarian cystectomy, chromotubation and a diagnostic hysteroscopy, dialation and curettage. My coder coded this as 58925, 58700 and 58559.
After I looked at the case, I coded it as being 58700, 58662, 58350 and 58559. Can anyone give me their thoughts on this case? I know that in some of these codes a modifier has to be added if the codes are correct.

Thanks,

 

[preserene]

Laparoscopic Procedure code 58661- for total or partial salpingectomy .The lap adhesiolysis would not be reported here separately, since it is considered by some payers as a part of the procedure: if massive adhesion and adhesiolysis done it can be appended with-59. Rt ovarian cystectomy is a separate and distinct procedure for the other side; it can be reported but I have a doubt here that it could be included in the adenexal lesion(s) treatment in 58661, (unless that code is for unilateral)
Hysterocsopic Procedures Code- It would go for 58558;
why would you go for 58559- It is for lysis of UTERINE (inside, in the cavity) Adhesion- otherwise called as Uterine synychae which is not documented in the op notes. There is no mention of uterine adhesion; so there is no need for the 58559.Chromotubation and becomes a part of the major procedure of hysteroscopy surgical. Hysteroscopy though was intended for diagnostic, the D&C procedure has been carried out with hysteroscopy( and I sure there would have been an endometrial biopsy/curettage sent for Path) ;so it becomes surgical, and so the diagnostic hysteroscopy will not be reported separately. For chromotubation since it is an involving procedure (time and work,
It can be appended with Mod-22
My suggestion would be , to sum up :
58661- 59, 58558-22. only

If the code 58661 applies for bilateral adenexal procedures, then the right ovarian cystectomy would merge into the same code ; or even you can append the same modifier – 59 with the physician documentation as a separate identifiable distinct procedure done on the right side ovary( Cystectomy).
Let us see there would be some experts who would come out with more precisely about the right ovarian cystectomy reporting. Other two codes I feel I am justified

 

[mslori7]

Hi,

Thanks so much for your help.

Lori