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Ob-Gyn Coding Alert

Coding Quiz Answers:
See How Your Hysterectomy Responses Measure Up

  Did you report combo code 58152 rather than 51840?
Got your answers handy? Check them against what our experts say.

Answer 1: You should report only 58150 (Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]). In general you should not separately code for a biopsy when the ob-gyn removes the area of the biopsy. 
 
Despite this not being a National Correct Coding Initiative edit, most payers will deny a cervical biopsy (57500, Biopsy, single or multiple, or local excision of lesion, with or without fulguration [separate procedure]) when the ob-gyn performs one at the time of a TAH. The one exception might be if the ob-gyn needed to perform the biopsy prior to determining if the patient needed a TAH/BSO. In that case, you may want to add modifier 59 (Distinct procedural service) to 57500.

Answer 2: Your coding for this scenario will depend on whether the ob-gyn documented that the patient has an enterocele or whether this repair was prophylactic in nature (not payable). Because the physician performed a TVH without removing the tubes and ovaries, you have two coding choices. As long as your ob-gyn documents an enterocele to repair, you would use 58270 (Vaginal hysterectomy, for uterus 250 grams or less; with repair of enterocele) or 58294 (Vaginal hysterectomy, for uterus greater than 250 grams; with repair of enterocele), says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.

Answer 3: You should use the combination code 58152 (Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]; with colpo-urethrocystopexy [e.g., Marshall-Marchetti-Krantz, Burch]). If you were to report 58150 and 51840 (Anterior vesicourethropexy, or urethropexy [e.g., Marshall-Marchetti-Krantz, Burch]; simple), most payers would think you-ve unbundled the parts of the combination code.

Answer 4: Many payers will deny the vaginal vault suspension for lack of medical necessity. The American College of Obstetricians and Gynecologists states that in the case of total or subtotal abdominal hysterectomies, -repairs or suspension procedure of vagina, urethra and perineum- are -examples of intraoperative services excluded from the global service.- Payers argue, however, that the suspension procedure is preventive rather than restorative at the time of the hysterectomy because the ob-gyn performs it to prevent the prolapse from happening in the future.

Generally, you can report the suspension if the payer doesn't bundle it into another procedure for which you-re coding. For instance, Medicare includes 57280 (Colpopexy, abdominal approach) with 58150. You cannot bypass this edit. Medicare, however, does not bundle [...]

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