Coding for Your Urogynecology Practice: Surgical and Office-based Procedures-Coding Video

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any code that you can code with an interaceal code. And so, that's where I was able to find that, and so you can trust the coding.<br /><br />Absolutely, and this is one of the reasons why I pay a subscription fee every year for my coding today. I looked at buying the paper book earlier on, but the fact is that new information on the NCCI edits come out a lot faster than they publish a new paper book, and I find that online, and having the ability to look at it from anywhere at my convenience is incredibly useful. And as I mentioned before, it's one of the first things I bring up on my computer every morning when I open my EMR. All right. We have another question. What if the patient has rectal fecal incontinence surgery by the colorectal surgeon at the same time? Does that change the codes for the apical pelvic repair that the female pelvic surgeon is doing at the same time? That's a good one. Jessica, you want to take that one? I mean, I think I would be inclined to say that you, you know, I don't quite understand fully what is meant by when they say the female pelvic surgeon is doing apical pelvic repair and then the colorectal surgeon is doing rectal fecal incontinence surgery. I mean, if the colorectal surgeon is doing rectoplastie at that time, then that's going to be a completely separate procedure. The female, you know, you can't code a, you know, female pelvic specific apical repair if the rectoplasty is being done, because that's a female pelvic specific prob-- the two are different. You know, if the female pelvic surgeon is doing a sacro-copal plexi and the colorectal surgeon is doing a pudendal nerve block or a posterior tibial nerve stimulator for the rectal fecal incontinence, then yes, you can code the two separately. But if they're, you know, and I think that is what the question is asking, but if I'm misunderstanding the question, if they don't mean that, then no, you cannot do that. That answer makes complete sense to me. I don't, I can't think of anything I would add to that. Okay, let's move on to the next one. Does therapy given on the same day as an E&M need a 59 or 76 modifier? This is the point we were discussing before. If it's the same diagnosis and it's part of the work up and the treatments of that diagnosis, my answer would be no. I would write a separate note though, and I would clearly document that if you're going to do an E&M that day and it's the same reason you're seeing the patient, the work that you did, your plan, the additional therapy you did, that should all be in one note. You shouldn't immediately bill for therapy as well. But if it's a separate problem, if there's a different diagnosis, again, you could use either the 59 or the 76 modifier. But remember, the 76 is really for the assistant, and the 59 is for a distinct procedure. But you can't bill for two separate E&Ms on the same day for different distinct problems. I would agree. I frequently will render therapy in the office, and I don't put a separate modifier on it simply because I feel that it is part of the overall patient management. But I do document the physical therapy I did. I'll often put PT as a separated section with separate heading in my note, documenting the specific exercises and therapies that I recommended, just so it's fully documented. But I don't bill for it separately. Okay, I'm going to ask this one to Doug. What modifier should I use when my partner is helping out with my emergency surgery patient late at night? Scott, that's the 82 modifier. That's the assistant at surgery and no resident is available. You actually put that modifier on that surgical bill, and that actually communicates to the insurance companies that's charged for both the insurance companies and billing companies, that's telling everybody that no other resident was available to help at that time, so that modifier is appropriate. There's another one I've been asking...<br /><br />And also, if you're calling beeper surgery, you might also be considered the assistor, if there are two-federally need-monitors carry a sterile PPE, and the assistant surgeon modifier would be appropriate as well.<br /><br />Yes, and you get an increase in your RVU value if you put that modifier on. Yeah. Okay, we had another one. I'm going to take a stab at this. So, this is a scenario. A patient is scheduled for a laparoscopic hysterectomy and states they have mild prolapse, would like sacropexy, and the surgeon agrees to do the sacral plexion with the adnexal removal with the hysterectomy. Does the 51 modifier have to be used? So, let me just clarify what the scenario is. So, the scenario is a patient comes in for a hysterectomy and says, "By the way, I also have a mild prolapse, can you fix that too?" And so, you schedule the surgery and you do both surgeries, and I'm assuming at the same time, with the same incisions. I typically would not use the 51 modifier because you are doing a separate procedure. Now, what procedure that was would depend on where you are. If you're doing a separate open sacropexy, then of course you would use 52 modifier because it's a staged surgery. But typically for that procedure, I would just include the other procedure, the sacral plexus, as long as it was the same side. On the other hand, if you say, "Well, my usual practice is to do a laparoscopic sacral plexus, even if it's mild prolapse, because that's the way I like to do it," I would typically code it that you just have two procedures and that you code the two procedures independently of one another. So, typically I would code that if it was laparoscopic sacral plexus as 57425 for the sacro-copal plexus, 58558 for the laparoscopic adnexal removal, and then 58662 for the laparoscopic hysterectomy. What do you all think?<br /><br />Scott, I completely disagree with you.<br /><br />Fine.<br /><br />I think Monty, Michelson disagrees with both of us. I think that the argument between you two guys is something that could go on forever, but what I'm going to go back to is look at your pacemaker. The question was, does the 51 modifier have to be used? Well, let's go back to the pacemaker. You get your guardian pacemaker in, your colleague goes in the room, which is the epilogue, he does the programming for the pacemaker. You would think, well, that he can't code for that. I say he can. He can. Again, it's an add-on code. There's not another add-on code for the guardian pacemaker. Yeah, okay, that's a great example. In this particular situation, that's interesting because you wouldn't use the 52 modifier for that. You would say that your partner is doing something distinct as a separate procedure, and so you would actually use either the 59 or the 51 modifier to do that. It depends on whether you're coding for a completely different procedure or you're coding for a distinct, a modifier 51, whether you're coding for a completely different procedure, a modifier 52, whether you're coding for a distinct part of the procedure, two separate diagnoses, a modifier 59. Would you not argue that the 59 modifier actually is most appropriate there? Yes, and I actually did talk to Monty about this, and I think the argument can be made either way, but I do think you're right. I do think that you use the 59 modifier. I think that is probably the most appropriate modifier because it is a distinct procedure that is being done that you would normally combine with the other procedure, but because it's separate, you can code it separately and with separate payment. Okay, another scenario. If a patient has recto-seal surgery by the colorectal surgeon at the same time with sacro-coccyx pectus by the female pelvic medicine and reconstructive surgeon, can the two surgeries be billed together? So I think we have addressed this one, but I want to make it clear. The answer is yes, they can be billed together. You would code the recto-seal surgery, the colorectal surgery, as it's billed, and you would code the sacro-coccyx pectus as it's billed, and you would use the appropriate modifier to increase the RVU value of the surgeon's payment, and they would both be coded correctly. Okay? I think that's even ignoring the fact that I think you could even build in the same insurance claim, even though they're done in completely different parts of the body, they're not integral parts of each other. I think you could still build them in the same claim, because they're surgical assistant, but that's a whole separate question. All right. Well, I think that is the conclusion of our questions. I'm going to pause for a moment. I'm going to ask Ms. Reid, if there is any... Lori, I'm going to ask if you have any burning questions or scenarios that you think that we didn't cover, but we should. So, Lori Reid is the OGS coding consultant. And you probably see her email address up there. Feel free to reach out to her if you have any questions about coding, particularly if they require detailed one-on-one discussion. She's a great resource. I rely on her a lot for this. So, Lori, are there any questions in your... How many questions that are burning that we haven't covered so far?<br /><br />It just seems to be one general question that's the most accurate guides for unlisted codes. So, I think this is what the question is about in general. I mean, in general, the unlisted codes in the CPT manual provide an opportunity to report the service or procedure that has not been given a specific code. So, those are general... Would you agree, Dr. Reid, would you agree?<br /><br />Yes, yes, that is correct.<br /><br />Okay, great. So, I think we've covered what we can in an hour. I want to remind you that the recording for this session will be available. I think that'll be announced. These sessions will be available to members of OGS and I think they have to be requested, but we'll... The full set of questions and answers we'll send out to everybody. If you have any other questions or things that were burning in your mind that you want to address, please reach out to the OGS office. I put my email address up there. Please feel free to reach out to me as well. I'll try to answer any coding or reimbursement questions I can. I think this is a good and useful session. I wanted to thank all the participants. I wanted to thank Jessica, Doug, and Laurie. I think you all did a great job. Hopefully next year we can all get back together and do this in person. Thanks a lot. I'll leave it there and turn it back over to OGS. Thanks, everyone.
Keywords
coding
NCCI edits
subscription fee
online access
rectal fecal incontinence surgery
apical pelvic repair
therapy
E&M
modifier
surgery