Key: According to Donna C. Kroening, CPC-OGS, reimbursement manager for the department of obstetrics and gynecology at the Medical College of Wisconsin, when you code hysterectomies, you-ll have to review these factors in this order:
- extent of uterus removed
- additional procedures performed. Step 1: Analyze Your Ob-gyn's Approach The first thing you must do is decide what approach your ob-gyn used. This will help you narrow down the code series you-ll work with.
Open procedures: For a hysterectomy performed via the abdominal approach, you should look to 58150-58240. If your ob-gyn performed a hysterectomy using a vaginal approach, you-ll pull a code from the 58260-58294 series.
Laparoscopic procedure: For a laparoscopic-assisted vaginal hysterectomy (LAVH), you-ll use 58550-58554. If your ob-gyn performed a supracervical laparoscopic hysterectomy, you-ll report one of four new-for-2007 codes: 58541-58544.
Why this is so important: -There's a big difference between laparoscopic hysterectomies and ones performed through a laparotomy incision -- hence, higher relative value units (RVUs) and expected reimbursement- for the open procedures, says Debbie Sixkiller, surgery coordinator for Dr. C. W. Randolph in Jacksonville Beach, Fla.
Step 2: Seek Out the Uterus- Size Next, you need to know the weight of the uterus -- specifically whether it was 250 grams or less or more than 250 grams. This will narrow your coding options.
If the uterus weighed 250 grams or less, you-ll use 58260-58270 for vaginal approach procedures. You-ll use 58550-58552 if your ob-gyn used a laparoscopic approach or 58541-58542 if she performed a supracervical laparoscopic hysterectomy.
On the other hand, if the uterus weighed more than 250 grams, you-ll use 58290-58294 for vaginal approach procedures. You-ll use 58553-58554 if the procedure was laparoscopic or 58543-58544 if the procedure was a supracervical laparoscopic hysterectomy.
Why this is so important: -Without knowing the weight of the uterus, you could be leaving money on the table,- Kroening says. -Be certain that your pathology report includes that. We-ve worked hard with our pathology department to make certain the weight is always there.- Step 3: Evaluate the Hysterectomy's Extent An open or laparoscopic hysterectomy may have included more than simply removing the uterus.
The hysterectomy may be total, but you may also see a [...]