REIMBURSEMENT ADVISER

■ BY MELANIE WITT, RN, CPC, MA

Hydrodistention, cystoscopy: we appeal? Also, should we have added modi- Why and what code? fier -22 (unusual procedural services) to 58661? First, keep in mind that payers always Can you enlighten me on therapeutic Areduce the allowable on the second pro- Qhydrodistention of the bladder: What is cedure performed, since they are paying for this for? What code would I use? A diagnostic only the intraservice work, not the procedure’s cystoscopy was also performed. entire global package. Cystoscopy with hydrodistention, usually Next: Code 58661 does not allow you to Adone as an outpatient procedure under bill additionally for ovarian cyst removal or cys- regional or general anesthesia, is used to diag- tic fluid aspiration, because the physician also nose and sometimes treat interstitial cystitis. removed the ovary. However, there is 1 scenario During cystoscopy, the inside of the blad- in which additional reimbursement is possible. der is examined. Then the bladder is filled to An oophorectomy is by definition the a high pressure with fluid (hydrodistended). removal of 1 ovary. For CPT codes in which This causes the bladder wall to stretch, allow- oophorectomy is an integral part of the proce- ing the physician to inspect for changes typical dure (eg, total abdominal hysterectomy/bilater- of interstitial cystitis. Hydrodistention may al salpingo-oophorectomy, open oophorectomy, reduce pain and discomfort in some intersti- open salpingo-oophorectomy) the language tial cystitis patients, and thus may be thera- indicates whether they are used to report a par- peutic as well as diagnostic. tial or total unilateral or bilateral removal. Code For this procedure, code either 52260 58661, however, only indicates “partial or total (Cystourethroscopy, with dilation of bladder oophorectomy”—leading to the belief that it for interstitial cystitis; general or conduction applies to only 1 side, not both. [spinal] anesthesia) or 52265 (… with local If a physician removes the ovary on 1 side, anesthesia). Be sure to verify the anesthesia but removes an ovarian cyst on the other, and type before billing for this service. if the payer agrees with this interpretation of the code, you might be able to bill both 58661 Low payment for cystectomy and 58662 (which covers both removal and with oophorectomy aspiration of the ovarian cyst), placing the modifiers -RT (right side) and -LT (left side) My physician removed a patient’s ovaries as appropriate. Still, many payers—including Qand also performed a dilation and curet- Medicare—do not agree with this interpreta- tage. We coded these procedures as 58661 tion and will not reimburse in this manner. (Laparoscopy, surgical; with removal of adnex- Your question, however, indicates that al structures [partial or total oophorectomy both ovaries were removed. Thus, additional and/or salpingectomy]) and 58120-51 (Dilation reimbursement is unlikely. ■ and curettage, diagnostic and/or therapeutic [nonobstetrical]; multiple procedure), but Ms. Witt, former program manager in the Department of Coding received extremely low reimbursement. and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation con- The operative report stated extensive work sultant. Reimbursement Adviser reflects the most commonly accepted was involved. An 8-cm ovarian cyst was interpretations of CPT-4 and ICD-9-CM coding. When in doubt excised, and some cystic fluid aspirated. Should on a coding or billing matter, check with your individual payer.

70 OBG MANAGEMENT • June 2004