Wiki Help with coding, modifier 22 and Unlisted procedure

[midnight1995]

I would appreciate any help with the attached Op note: the following is what the provider is actually coding;
Provider Correct billing
50715: 50 modifier 58558
52000 50715: Modifier 50 & 59
56605 58545
58350 58662: Modifier 22: In the Op note I am not finding supporting documentation
58545 58660: cannot be billed included with 58545/58662 cannot override with modifier
58558 52000: Modifier 59
58660: 50 modifier 58350: Modifier 59
58661 56605
58662: Modifier 22 58679: Modifier 50: In the Op note this is being used for the Robot assisted excision of endometriosis
58679 Unlisted : modifier 50 58661

Any help is greatly appreciated

 

[nielynco]

I would appreciate any help with the attached Op note: the following is what the provider is actually coding;
Provider Correct billing
50715: 50 modifier 58558
52000 50715: Modifier 50 & 59
56605 58545
58350 58662: Modifier 22: In the Op note I am not finding supporting documentation
58545 58660: cannot be billed included with 58545/58662 cannot override with modifier
58558 52000: Modifier 59
58660: 50 modifier 58350: Modifier 59
58661 56605
58662: Modifier 22 58679: Modifier 50: In the Op note this is being used for the Robot assisted excision of endometriosis
58679 Unlisted : modifier 50 58661

Any help is greatly appreciated

First, the op note does not describe ureterolysis (freeing of constricting adhesions around the ureters) and in any case, 50715 is not a laparoscopic approach code so could not be billed even if it were documented. Instead, she removed endometrial implants on ligaments an in spaces and did so extensively. 58661 (removal of an ovary) was not documented at all. A 50 modifier is not applicable to any of the codes that should be billed. I am getting 58545, 58662-22 for the endometrial implant removal which was extensive, 58560-51 for the septum, 58558-51 for the polyp removal, 56605-51 (for this clitoral wart removal), 58350-59 (for chromo) and 52000-59 (for cystoscopy). The adhesiolysis performed would not warrant a separate code or a modifier 22 in my opinion. There is no code for suspending the ovaries and her description is very sketchy in any case. I would just through that it with the more extensive work in removing all those implants.

 

[Cmama12]

Further to this, the cystoscopy would not be separately billable either if they are checking their work, which is usually the case. A cystourethroscopy (e.g., CPT code 52000) or cystourethroscopy with ureteroscopy (e.g., CPT code 52351) performed near the termination of an intra-abdominal, intra-pelvic, or retroperitoneal surgical procedure to assure that there was no intraoperative injury to the ureters or urinary bladder and that they are functioning properly is not separately reportable with the surgical procedure.

 

[nielynco]

Further to this, the cystoscopy would not be separately billable either if they are checking their work, which is usually the case. A cystourethroscopy (e.g., CPT code 52000) or cystourethroscopy with ureteroscopy (e.g., CPT code 52351) performed near the termination of an intra-abdominal, intra-pelvic, or retroperitoneal surgical procedure to assure that there was no intraoperative injury to the ureters or urinary bladder and that they are functioning properly is not separately reportable with the surgical procedure.

In this case, the op note makes it clear that the cystoscopy was planned as a diagnostic procedure (as was the chromotubation). In that case it can be billed.