Ob-Gyn CCI 16.0: Hysterectomy Coding

Posted on 22. Jan, 2010 by Editor in Hot Coding Topics

Here’s where you can bypass the edits with modifier 59.

The Correct Coding Initiative (CCI) version 16.0 didn’t overlook the hysterectomy, vaginal graft, and colpopexy codes — nor should you. To make sense of the deletions, break these additions into mutually exclusive and non-mutually exclusive.

Note: In all these cases — except those involving the anesthetic injection codes, you can bypass the edits with a modifier (such as 59, Distinct procedural services). You must have documentation to support the modifier’s use.

Cross Out This Hysterectomy Bundle

CMS deleted the non-mutually exclusive bundle of 58292 (Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube[s] and/or ovary[s], with repair of enterocele) as the column 2 code to 58294 (… with repair of enterocele), but then re-added it in reverse order.

Code 58292 is the column 1 code, and 58294 is the column 2 code. You won’t get paid for a column 2 code performed on the same day as the associated column 1 code – unless the edits permit you to use a modifier, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, consultant with MJH Consulting in Denver.

Rationale: Reversing the order corrects the fact that 58292 has a higher relative value unit (RVU). Also, CMS does not consider the two codes mutually exclusive. The only difference between these two vaginal hysterectomy codes is that one includes removal of the tubes and ovaries, while the other does not.

Make Sense of These Mutually Exclusive Edits

Hysterectomy: The first set of mutually exclusive edits affect hysterectomy procedures. Codes 58263 (Vaginal hysterectomy, for uterus 250 g or less; with removal of tube[s], and/or ovary[s], with repair of enterocele) and 58270 (Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele) are now part of 58280...

Tags: CCI, hysterectomy, modifier 59, mutually exclusive, non-mutually exclusive, ob-gyn, urodynamic, vaginal graft