Ob-Gyn Coding Alert

Reader Question:
Ligation Complicates Laparoscopic LSO

Question: What is the procedure code for laparo-scopic left salpingo-oophorectomy with ligation of an arterial pumper? California Subscriber Answer: The correct code is 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]). Billing separately for the ligation of the arterial bleeder depends on the cause of the bleeding. If it is a result of normal hemostasis, the ligation is included in the procedure as a standard. If the bleeding is due to a mishap during surgery, some payers may include the artery repair in the procedure. For instance, Medicare never pays you to repair a mishap, but other payers may allow it. If there was bleeding prior to the surgery, you can attempt to bill 37617 (Ligation, major artery [e.g., post-traumatic, rupture]; abdomen), or you can simply add modifier -22 (Unusual procedural services) to 58661.  

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