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  1. Lori Posted 2 month(s) agoRelated Topics

    I have a provider who coded 58720 & 58925. I don't think this is correct as both procedures were performed on the left side and the left tube & ovary were removed. The left ovary did have a cyst but the entire adnexa on the left side was necrotic due to torsion. When I run the codes through the CCI edit checker, there is no flag but the 58720 is a "separate procedure" requiring a MOD 59. Can these two codes be billed together if done unilaterally on the same side?

  2. SuperCoder Posted 2 month(s) ago

    Hi Lori,

    These two codes cannot be billed together as both were performed on same side. Also see the rationale below including the link.

    Since in your case left ovary did have a cyst but the entire adnexa on the left side was necrotic, we would recommend using 58720 only. Through an open approach, the physician either completely or partially removes the ovary(s)/fallopian tube(s). Patients undergo this procedure for neoplasms, cysts, hematomas, prolapse, torsion, and so on. Check exactly with the operative report what was performed and then decide accordingly.

    Secondly: If one of the services has a “separate procedure” designation in CPT. Essentially, these procedures are considered an integral component of another procedure or service and are not separately reported. Separate procedure codes can be reported if they are performed independently or as a distinct or unrelated service from other procedures also being reported. In these situations, the 59 modifier is appended to the code with the separate procedure designation.If one of the services has a “separate procedure” designation in CPT. Essentially, these procedures are considered an integral component of another procedure or service and are not separately reported. Separate procedure codes can be reported if they are performed independently or as a distinct or unrelated service from other procedures also being reported. In these situations, the 59 modifier is appended to the code with the separate procedure designation.

    http://www.codingandcompliance.com/news/NewsArticleFiles/MultipleSurgProcedures.pdf

    Please feel free to ask for any further query.

     

     

  3. Lori Posted 1 month(s) ago

    Thank you. I didn't think they could be billed together. It's just nice to be validated!!

  4. SuperCoder Posted 1 month(s) ago

    Happy to help! Thank you.

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  • Posted by 7520 Lori, 2 month(s) ago. There are 4 posts. The latest reply is from SuperCoder.