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Ob-Gyn Coding Alert

Reader Question:

C-section and Hysterectomy

Question: A C-section was done, and the patient had a hysterectomy with a left salpingo-oophorectomy. Should I code 59510 (routine obstetric care including antepartum care, cesarean delivery and postpartum care) (the patient rendered her care with our practice), plus 59525 (subtotal or total hysterectomy after cesarean delivery) with 58720-59 (salpingo-oophorectomy, complete or partial, unilateral or bilateral [separate procedure] [distinct procedural service]), or, should I code 59510 and 58150 (total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s])?

Jennifer Patronik
Copperfield Ob/Gyn, Concord, N.C.

Answer: This is a very good question because 59525 does not mention the removal of tubes or ovaries. It is the convention in CPT, however, to include removal of tubes or ovaries when a hysterectomy is performed (that is, it does not matter whether the tubes and ovaries are removed, reimbursement would be the same) and although 59525 is not specific on this point, the spirit of the procedure implies that this procedure probably carries the same intent as the other hysterectomy codes. To this effect, ACOG committee on coding and nomenclature has recommended that the removal of tubes and ovaries at the time of hysterectomy following cesarean be an included procedure that should not be billed separately.

As to billing for the procedure, you will bill for the global delivery 59510 and then 59525 with no modifier. This is because 59525 is a CPT add-on code that has been valued under RBRVS with the assumption that it can only be billed at the time of another procedure (cesarean in this case) so it has received reduced RVUs. This reduction in RVU is a little less than half the physician work RVUs for a regular hysterectomy which is equivalent to a 50-percent reduction for the second procedure15.24 RVUs for 58150 vs. 8.54 for 59525. If your physician believes that the removal of the left tube and ovary was particularly difficult, a modifier -22 (unusual procedural services) can be added to 59525, but you will need to submit documentation with the claim in support of additional payment.