06-2013 Case of the Month

JuneCase-img

What would you do in this this case?

A 31-year-old woman (gravida 2, para 1) presents to your office at 6 weeks’ gestation.  She is complaining of vaginal bleeding and pelvic pain.  You perform an evaluation and management (E&M) service and ultrasonography and diagnose an ectopic pregnancy.  After discussing the options with her, you perform a laparoscopic salpingectomy on her later that afternoon. 

How would you code this? 

A. Code only for the laparoscopic salpingectomy since the E&M service and ultrasonography are within the global period and therefore part of the global surgical package.

B.Code for the laparoscopic salpingectomy and the ultrasonography but not the E&M service since the E&M service is within 24 hours of the surgery and therefore part of the global surgical package.

C.Code for the E&M service, the ultrasonography, and the laparoscopic salpingectomy separately.  I may have to appeal the denial of the E&M service if the third party payer considers it part of the global surgical package.

D.Code for the E&M service, the ultrasonography, and the laparoscopic salpingectomy separately. I would place the -57 modifier on the E&M service to signify that this was the E&M service that resulted in the decision for surgery.  I would expect to be reimbursed for all 3 procedures since the decision for surgery is never part of the global surgical package.

E.Wait for the operative note to arrive in my office and my staff would code for the procedure.

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Answer D is correct: Code for the E&M service, ultrasonography, and laparoscopic salpingectomy separately. Place the -57 modifier on the E&M service to signify that this was the E&M service that resulted in the decision for surgery. Expect to be reimbursed for all 3 procedures since the decision for surgery is never part of the global surgical package.

Rationale: Laparoscopic salpingectomy for treatment of an ectopic pregnancy (CPT code 59151) has a global period of 90 days. In this case, the E&M service is not part of the global package provided with the surgical procedure because it was the E&M service that resulted in the decision to perform the surgical procedure. The E&M service that results in the decision to perform surgery is never part of the global surgical package. If that E&M service is provided within the global period, then the -57 modifier would be used to signify that fact; otherwise the 3rd party payer might think that it was just the typical E&M included in the global package. The ultrasonography for diagnosing the ectopic pregnancy also is not included in either the E&M or the surgical procedure. Practically it is never a good idea to wait for the operative note before coding and billing for surgical procedures. This will delay coding and billing. If the operative note never arrives, there is no initiative to code and bill for the procedure. It is best if the physician performing the procedure does the coding, not the office staff. Only the physician knows exactly what was done and any extenuating circumstances that might affect the coding.

Learn more about this topic while earning CME at ASRM eLearn®.  

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