The SGO Coding Committee promotes new and revised codes to help optimize billing efficiency and reimbursement for gynecologic oncologists. These efforts ensure that the use of standard terms and descriptors to document procedures in the medical record reflect current medical practice. The Committee also works with the American Congress of Obstetricians and Gynecologists to provide recommendations and support for proposals through the American Medical Association to ultimately receive approval by the Centers for Medicare & Medicaid Services. In addition, the Committee interfaces with national and government agencies on practice management and reimbursement issues.
Coding Corner: Cesarean hysterectomy | Mary J. Cunningham, MD
It is not uncommon for a gynecologic oncologist to be consulted when a hysterectomy must be performed at the time of cesarean section. The way in which the surgery is coded depends on the details of who performed each part of the procedure. The code for subtotal or total hysterectomy after cesarean delivery is +59525– RVU(relative value unit) 12.80. The “+” indicates an add-on code that must be billed in combination with other specified codes. In this case +59525 needs to be billed in addition to the appropriate delivery code (59510, 59514, 59515, 59618, 59620, 59622).
In the description of every add-on code in CPT there is a parenthetical statement that lists the acceptable codes that must be used in conjunction with the add-on code. If the obstetrician performs both the cesarean section and the hysterectomy then these codes can be used.
If the OB/GYN performs the cesarean delivery and the gynecologic oncologist performs the hysterectomy, the Gyn Onc can bill 58150 for a total hysterectomy (RVU 27.31) or 58180 for a supracervical hysterectomy (RVU 25.83). The obstetrician will separately bill the delivery.
The diagnosis codes most commonly used for these procedures are found in the obstetrics section of ICD-10: O42.2 Morbidly adherent placenta (with subcategories for accreta, increta and percreta as well as trimester) and O72.0 postpartum hemorrhage with adherent placenta.
In conclusion, correct coding for a hysterectomy at the time of cesarean delivery requires considering the role that each surgeon played during the procedure.
Mary J. Cunningham, MD, is a gynecologic oncologist at GYN Oncology of Central New York, and Director of Gynecologic Oncology at SUNY Upstate Medical University in Syracuse, NY.
SGO Coding Q & A
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Common Surgical Procedures
- 2016 Relative Value Units (RVUs) for procedures commonly performed by SGO members.
Medicare Global Surgery Modifiers
The Medicare Global Surgery Modifiers document lists commonly reported modifiers along with information about proper usage and documentation.
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SGO ConnectTM Ed
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