Coding Corner: Billing for Emergency Surgery | Andrew Menzin, MD, MBA, FACOG, FACS

Andrew Menzin, MD, MBA, FACOG, FACS

Scenario: My patient with a history of ovarian cancer came to the emergency department (ED) with abdominal pain and was found to have a bowel perforation. I took her to the operating room for a diverting colostomy. Can I bill for ED evaluation?

Yes. Billing for this scenario includes two elements: (1) the ED evaluation during which the determination is made to confirm a large bowel perforation and make a decision to urgently proceed with exploration, and (2) the operative procedure. For the ED evaluation, the diagnosis codes of C56.9 (ovarian cancer) and K63.1 (large bowel perforation) should be selected and linked with an E/M service of initial hospital care (99221, 2, or 3), depending on the complexity of the service or based on the time required for the evaluation. The Decision for Surgery modifier (-57) should be appended to the E/M service code because the E/M service and the procedure were performed within 24 hours. As to the procedure itself, if a partial resection (of the perforated area) in conjunction with an end colostomy and closure of the distal segment (Hartmann procedure) was performed, the CPT code 44143 should be used.

Andrew Menzin, MD, MBA, FACOG, FACS, is a gynecologic oncologist at Northwell Health in Manhasset, NY.