Coding

Coding

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.

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Please note: The Coding Taskforce will not review operative reports but are happy to assist with specific coding questions. Please provide a synopsis of the case along with your question(s).

Disclaimer: SGO members and professional coders may seek coding advice and recommendations by submitting an email to coding@sgo.org. Answers to incoming questions are provided by the members of the SGO Coding and Reimbursement Taskforce and represent their opinion based upon the current and usual practices in the field. Every effort is made to ensure the accuracy of the information provided. However, the information neither replaces information in Medicare regulations, the CPT-4 code book, or the ICD-10 CM code book; nor does it constitute legal advice. Responses to questions are intended only as a guide and are not a substitute for specific accounting or legal opinions. SGO expressly disclaims all responsibility and liability arising from use of, or reliance upon this information as a reference source, and assumes no responsibility or liability for any claims that may result directly or indirectly from use of this information, including, but not limited to, claims of Medicare or insurance fraud.

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Common Surgical Procedures

Medicare Global Surgery Modifiers

The Medicare Global Surgery Modifiers document lists commonly reported modifiers along with information about proper usage and documentation.

Patient Assessment Forms

SGO ConnectTM Ed

SGO offers a variety of online learning opportunities about coding and compliance issues through SGO Connect Ed, including the four-part 2012 coding webinar series.