Cindy Posted Mon 13th of January, 2020 15:43:32 PM
Hello - Procedures performed: Robotic Excision of Endometriosis Simple, Myomectomy, Presacral Neurectomy, and Appendectomy. Preop Diagnoses: Endometriosis of pelvic peritoneum N80.3, Endometriosis of Uterus N80.0, Pelvic pain in female R10.2. Post-op Diagnoses: Same plus uterine fibroid and turgid appendix. The claim was submitted with the following CPT Codes: 58545, 58578 (unlisted code representing presacral neurectomy), and 58662. The payer reimbursed on 58545 and denied 58662 as incidental to primary procedure (58545). Denial was upheld on appeal. My question: Is it appropriate to add modifier -59 to CPT 58662 in this case to indicate the excision of endo was a separate procedure? Here are details from the surgery: Provider removed 1 cm anterior uterine fibroid. There was evidence of old excision of endometriosis. Difficult to tell exactly what was scar tissue versus new endometriosis, however, suspect areas on the right side of the cul-de-sac as well as the left upper pelvic sidewall were excised. The right side of the cul-de-sac bordered on the edge of the rectum and area was reinforced by closing the perirectal fat over the rectum. Appendix was turgid and densely adherent to the abdominal wall as was the cecum. If more details are needed, please let me know. Thank you, Janet
SuperCoder Answered Tue 14th of January, 2020 06:33:09 AM
As per clinical responsibility of CPT 58662, it is used if the provider is performing robotic surgery, he docks the robot to the laparoscope at this time. Typically, the provider removes endometriosis during this procedure or other lesions, such as cysts, on the uterus, ovaries, fallopian tubes, and other pelvic structures. To do this, the provider excises, vaporizes, or cauterizes lesions or endometrial implants in the anterior or posterior cul–de–sacs, the two small pouches on either side of the uterus, and other areas, being careful not to damage the ureters, colon, or blood vessels. The provider removes any specimens from the abdomen through the closest trocar site. He then performs chromotubation, if necessary, to check the openness of the fallopian tubes. He irrigates and deflates the abdominal cavity, and removes all instruments and trocars. Finally, he closes the trocar site fascia and skin and removes all instruments from the vagina.
As per the general CCI edits, you can bill CPT 58545 with 58662 without adding any modifier as there is no CCI conflict in between these two codes. Some payers required modifier to differentiate the separate procedure. Please check your payer specific guidelines.
Some payers like to append modifier 22 (Increased procedural services) to account for the extra work involved like excision of simple lesion with myomectomy procedure. Please check your documentation and code accordingly.
Hope this helps!