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Surgery advice

Tonya Posted Wed 30th of June, 2010 18:16:02 PM

I need some advice.

Operation: D&C with frozen section of endometrial curettings
Diag Laparoscopy

Doc did a D&C prior to other procedures and sent to Path. An LAVH was planned. He started the LAVH and and then was contacted by Path that the specimen was suggestive of a high grade tumor. Therefore, the decision was made to change to a TAH w/BSO. Another doc did the staging and lymph node dissection.

Would you code this:
58150-22 (does anyone ever get paid for this in additional $$$???) would anyone use the 58552-52)
58120 ??

Thanks in advance.

SuperCoder Answered Thu 01st of July, 2010 07:01:10 AM

Since, the procedure was initially started with an LAVH but later got converted into open TAH w/BSO along with lymph node dessection, so you can code 58210 along with V64.41. You can add 22 modifier but you need to provide substantial documentation to insurance, mentioning the extra amount of time consumed and extra work performed. If the lymph node dessection is perfomed during the same session by a different phy then you can add a modifier 80,81 or 82.

SuperCoder Answered Thu 01st of July, 2010 10:36:13 AM

I forgot to mention that you can also report 62 modifier in this case but, don't report the two separate CPT codes for TAH w/BAH and node dissection. To get payments for both the physician some points should be remembered
(a)Both physicians should write their own operative notes and identify each other as co-surgeons.
(b)Both physicians should use the same ICD-9 codes so that the diagnoses agree.
(c)Both co-surgeons should submit their own HCFA 1500 forms and provide their own documentation.

I believe that the best way to handle the situation is to contact the [payers] office beforehand about the co-surgery situation, perhaps during scheduling of the procedure and coordination of the surgery.

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