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Ob-Gyn Coding Alert

Op Note Coding Clinic:
Is Coding for Multiple Procedures Confusing You? Learn From This Case Study and Get Full Reimbursement

" Ob-gyns frequently perform more than one procedure during a surgical session, so if you're not reporting each service properly, you could be leaving significant reimbursement on the table.
 
For example, your operative note reads:
 
Exploratory laparotomy, removal of painful keloid scar from previous surgery, extensive lysis of adhesions (ovaries, 4-6 feet of small intestines, bowel, pelvic). Bilateral salpingo-oophorectomy because of ovarian malignancy and repair of incidental bladder cystotomy.
 
Don't let the number of procedures confuse you. If you always follow six easy steps, you can ensure your practice receives the payment it deserves, says Penny Schraufnagel, office manager for Ob-Gyn Center PA in Boise, Idaho, and other coding experts:
 
1. List all the procedures the ob-gyn performed.
 
2. Assign a CPT code to each of the procedures listed (if you can't find a code for some, use an unlisted-procedure code or see if you can add the extra work into the primary procedure).
 
3. Eliminate codes that are always bundled (for example, you should always bundle an exploratory laparotomy when performed with an abdominal procedure).
 
4. Check to see if CPT or the National Correct Coding Initiative (NCCI) bundles any of the remaining procedures (but remember that you may be able to bypass the edit using a modifier if you meet the criteria).
 
5. Assign at least one justifying ICD-9 code to the procedures that remain (if you don't have a justifying ICD-9 code, you won't get paid).
 
6. List the procedure codes on the claim form in the correct order from the one with the highest relative value units (RVUs) assigned under the Medicare Physician Fee Schedule to the lowest. Take It Step-by-Step For the above operative note, you would list all of the following procedures and assign these codes:
 
 Exploratory laparotomy 49000 (Exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure])
   Removal of painful keloid scar from previous surgery 13100-13102 (Repair, complex, trunk )
   Extensive lysis of adhesions for the ovaries and   pelvis, use 58740 (Lysis of adhesions [salpingolysis, ovariolysis]), and for the 4-6 feet of small intestines,   use 44005 (Enterolysis [freeing of intestinal adhesion]  [separate procedure])
   Bilateral salpingo-oophorectomy 58720 (Salpingo-oophorectomy, complete or partial,    unilateral or bilateral [separate procedure])
   Repair of incidental bladder cystotomy 51860 (Cystorrhaphy, suture of bladder wound, injury or rupture; simple) or 51865 ( complicated). The exploratory laparotomy is always bundled into a more extensive procedure, so you would not report it separately, says Terry A. Fletcher, CPC, CCS-P, CCS, a healthcare coding consultant in Laguna Beach, Calif. As for the keloid scar, if it is located where the incision for the current surgery was performed, you will not be reimbursed for it. Therefore, you shouldn't bill separately for it either, Fletcher adds.
 
That leaves 44005, 58720, 58740, and 51860 or 51865. Both 44005 and 58720 are [...]

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