I'm looking for

Coding Corner: Coding for Aborted Radical Hysterectomy | Stephen Bush II, MD

Stephen Bush, II, MD

Gynecologic oncologists have all encountered situations where intraoperative conditions force them to change or abandon their surgical plans.  Stephen Bush II MD, a member of the SGO Coding Subcommittee, describes a coding situation which provides a great template for the thinking process behind a discontinued procedure.

A 25-year-old with a stage 1B2 squamous cell carcinoma of the cervix is scheduled for a radical abdominal hysterectomy with bilateral ovarian transposition. The procedure is started. The retroperitoneum is opened and an enlarged common iliac lymph node is sent for frozen section.  While waiting for frozen results, the retroperitoneal spaces are further opened and explored. No other enlarged lymph nodes are found. The pathologist calls: squamous cell carcinoma is identified in the enlarged common iliac lymph node. The radical hysterectomy is aborted and the ovaries are transposed above the pelvic brim. The para aortic lymph nodes are removed.

Relevant Codes:

58825:  Ovarian Transposition (11.78 wRVU)

58210:  Radical abdominal hysterectomy with bilateral total pelvic lymphadenectomy and para-aoritc lymph node sampling (biopsy), with or without removal of tube (s), with or without removal of ovary (s).  (30.91 wRVU)

38562:  Limited lymphadenectomy for staging; pelvic and para-aortic. (11.06 wRVU)

49010:  Exploration, retroperitoneum with or without biopsy (s).  (16.06 wRVU)

38770:  Pelvic Lymphadenectomy, including external iliac, hypogastric, and obturator nodes.  (14.06 wRVU)  Can use modifier 50 for bilateral procedure which would yield (14.06 x150%= 21.09 wRVU).

38780:  Retroperitoneal transabdominal lymphadenectomy, extensive, including pelic, aortic, and renal nodes.  (17.7 wRVU). Cannot use bilateral modifier.

The best way to code this procedure would depend on the extent of lymphadenectomy performed.  In the event a complete bilateral pelvic lymphadenectomy is performed the best code is 38770-50 (21.09 wRVU) in addition to 58225 (11.78 x 50% reduction = 5.89 wRVU) for a total of 26.98 wRVU.  If only a few lymph nodes are removed the better code would be 49010 (16.06 wRVU) plus 58225 (5.89 wRVU after 2nd procedure reduction) for a total of 21.95 wRVU.  One could also consider using 58210-52 or -53 for reduced or discontinued procedural services.

However, 52 or 53 modifiers will result in significant and sometimes unpredictable reduction in reimbursement. A52 modifier is used to report a serviced or procedure that is partially reduced or eliminated at the physician’s election. A53 modifier should be submitted with surgical codes or medical diagnostic codes when the procedure is discontinued because of extenuating circumstances after anesthesia is administered. For either code there should be good documentation of why the procedure was cancelled or aborted and the length/amount of procedure completed. Given other codes that more accurately describe procedure performed this may be unnecessary.

In addition to the above scenario 49010 may be a useful code for gynecologic oncologists to be familiar with when called to help a general OB/GYN colleague identify retroperitoneal anatomy.

Stephen Bush II, MD is a gynecologic oncologist at Charleston Area Medical Center/WVU Charleston in Charleston, WV.

SGO 2020 Coding Course Webinar Series

Evaluation and Management (E/M) codes will undergo their biggest change since 1992, effective Jan. 1, 2021. Stay ahead of the evolving reimbursement landscape with the two-part SGO 2020 Coding Course webinar series. Part 1 of this series, “Evaluation and Management Coding for 2021,” is scheduled for Wednesday, Sept. 16 at 7:00 p.m. CT / 8:00 p.m. ET. The webinar will be presented by Brad Hart, MBA, MS, CMPE, CPCP, CPMA, COBGC, from Reproductive Medicine Administrative Consulting, Inc. in Gastonia, NC, and moderated by Mary Cunningham, MD, from Upstate Medical University in Syracuse, NY. The second webinar, “Current Topics in Coding: Telehealth, Modifiers, Documenting Medical Decision Making,” is scheduled for Wednesday, Oct. 14 at 7:00 p.m. CT / 8:00 p.m. ET. The cost for the webinar series is $120 for SGO members and $150 for non-members. Office billing staff is welcome to attend. SGO is offering 3 hours of CE. Register now.

Coding Q & A

Our Coding Task Force members are happy to answer your coding questions, but are unable to review individual operative reports.

Ask a coding question

SGO members and professional coders may seek coding advice and recommendations by submitting the form.
Answers to incoming questions are provided by the members of the SGO Coding and Reimbursement Task Force 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.

Useful Coding Tools for Gynecologic Oncology

Jun 1, 2016

2016 Relative Value Units (RVUs) Procedures Commonly Performed by SGO Members

Type: Coding Tools
Type: Coding
Sep 1, 2012

Medicare Global Surgery Modifier Proper Usage and Documentation

Type: Coding Tools
Type: Coding
Sep 1, 2012

GYN SOS form

Type: Coding Tools
Type: Coding
Mar 12, 2020

Coding Corner: Telemedicine Billing

Type: Coding Tools
Type: CodingCoronavirusTelemedicine
Apr 1, 2020

Telemedicine Considerations During the COVID-19 Pandemic

Type: Recommendations
Type: CoronavirusTelemedicine
Feb 21, 2019

Coding Corner: Brachytherapy Coding | James J. Burke II, MD

Type: Coding Tools
Type: Coding
Sep 5, 2019

Coding Corner: Ovarian Cancer Debulking | Eileen M. Segreti, MD

Type: Coding Tools
Type: Coding
Jan 10, 2019

Coding for SLN procedures: 2019 changes for staff use | David O. Holtz, MD

Type: Coding Tools
Type: Coding
Apr 11, 2019

Coding Corner: Medicare rules for teaching hospitals | David Holtz, MD

Type: Coding Tools
Type: Coding

Find Other Practice Management Resources

Find anything you need from SGO regarding practice management, patient advocacy, papers and the like. Our resource library is here to help you succeed in treating your patients.