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help with surgery codes, add- 22 or reduced service to 2nd code

Susan Posted Fri 16th of September, 2016 17:03:33 PM
Procedure was laproscopic excision of bilateral endometriomas with stage 4 endometriosis and extensive adhesions. I'm using 58662-22. Secondary was attempt to remove an intramural fibroid noted on pelvic mri. When dr. entered the uterus no fibroid was found and it was closed-noted on op report as hysterotomy. I thought maybe 58545-52,51 would work. I notice that 58545 has more RVU's then 58662 and I know insurance will reverse the codes and pay both at half of allowable. They also tend to ignore -22 modifiers. Any advice on which approach would be best?
SuperCoder Answered Mon 19th of September, 2016 07:13:00 AM

Hi, our team is working on it and will get back to you.

SuperCoder Answered Tue 20th of September, 2016 05:31:05 AM

Hi,

As per documentation the appropriate CPT code is 58662-22 only. CPT 58545-52,51 will not be coded as there no procedure performed related to intramural fibroid. 52 modifier is used along with 58545 when surgeon reduce the service while performing intramural fibroid related procedure. 

NOTE: As per NCCI, when multiple endoscopic procedures are performed at the same patient encounter, the most comprehensive code accurately describing the service(s) performed should be reported. If several procedures not included in a more comprehensive code are performed at the same endoscopic session, multiple HCPCS/CPT codes may be reported with modifier 51.

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