How to Make Sense of Your Hysterectomy Combo Claims?
Explore comprehensive coding strategies for hysterectomies in OBGYN billing, including approaches for stress incontinence procedures, vaginectomies, lymph node sampling, and enterocele repairs.
OB/GYN Medical Billing & Coding Alert
When faced with two potential coding options, it's important to consider RVUs.
When coding hysterectomies last month, recall how you previously considered the OB/GYN’s approach, uterine size/weight, and the procedure's extent. That’s only part of the picture.
It’s also essential to account for any additional procedures the OB/GYN may perform during the same surgery and ensure they are coded accurately to capture all services provided.
Hysterectomy With Stress Incontinence Procedure - Multiple Options
When an OBGYN performs bladder and/or urethra fixation for stress incontinence alongside a hysterectomy, we have two coding options available. Depending on the fixation technique used, the physician may refer to it as a “Marshall-Marchetti-Krantz,” “Burch,” or “Pereyra” procedure.
For an abdominal approach, we should use code 58152, which corresponds to a total abdominal hysterectomy (including the corpus and cervix) with or without the removal of the tubes or ovaries, along with colpo-urethrocystopexy (e.g., Marshall-Marchetti-Krantz or Burch).
For a vaginal approach, the appropriate code is 58267, which applies to a vaginal hysterectomy for a uterus weighing 250 grams or less, with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type or Pereyra type) and may include endoscopic control.
Codes For Hysterectomy With Vaginectomy
Hysterectomies that involve partial or total vaginectomies (colpectomies) have specific coding guidelines.
For instance, if your OB/GYN conducts an open hysterectomy, you should use code 58200, which represents a total abdominal hysterectomy that includes a partial vaginectomy along with para-aortic and pelvic lymph node sampling, with or without the removal of tubes or ovaries.
Code 58200 not only covers the removal of the uterus but also includes a partial vaginectomy and potentially some parametrial tissue removal. This procedure is typically performed when endometrial cancer has spread to the cervix or parametrium, according to Melanie Witt, RN, MA.
It's important to note that codes 58210 (Radical abdominal hysterectomy with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling, with or without the removal of tubes or ovaries) and 58548 (Laparoscopic radical hysterectomy with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling, including the removal of tubes and ovaries if applicable) also account for the removal of parametrial tissue, as they are radical procedures that involve a vaginectomy, specifically the upper one-third of the vagina, Witt explains.
If the OB/GYN performs the procedure through a vaginal approach. In that case, you should use either 58275 (Vaginal hysterectomy with total or partial vaginectomy), 58280 (with repair of enterocele), or 58285 (radical vaginal hysterectomy, Schauta type operation).
Codes For Hysterectomy With Lymph Node Sampling
When an OBGYN conducts a para-aortic and pelvic lymph node sampling, they perform a lymph node biopsy. This procedure can only be done via an abdominal approach in conjunction with a hysterectomy. For this service, you would report 58200. This procedure may also be referred to as a "modified radical" abdominal hysterectomy, which includes a partial vaginectomy.
Conversely, if your OBGYN performs a bilateral pelvic lymphadenectomy and para-aortic lymph node sampling, you should use 58210 for the abdominal approach or 58548 for the laparoscopic approach.
Ovarian or Endometrial Cancer Broadens Your Choices
When managing cases of ovarian or uterine cancer, it's essential to consider four additional codes that may more accurately reflect the procedures performed. Your coding options include:
- 58951: Resection (initial) of ovarian, tubal, or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic, and limited para-aortic lymphadenectomy.
- 58953: Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy, and radical dissection for debulking.
- 58954: Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy, and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy.
- 58956: Bilateral salpingo-oophorectomy with total omentectomy and total abdominal hysterectomy for malignancy.
Enterocele Repair Codes - Enter Correctly
Enterocele repair combination codes include those for hysterectomies. For a vaginal approach, the following codes apply:
- 58263: Vaginal hysterectomy for a uterus weighing 250 grams or less, with removal of tubes and/or ovaries, and repair of enterocele.
- 58270: Vaginal hysterectomy for a uterus weighing 250 grams or less, with repair of enterocele.
- 58280: Vaginal hysterectomy with total or partial vaginectomy, and repair of enterocele.
- 58292: Vaginal hysterectomy for a uterus greater than 250 grams, with removal of tubes and/or ovaries, and repair of enterocele.
- 58294: Vaginal hysterectomy with repair of enterocele.
It's important to note that while there are codes for vaginal hysterectomies with enterocele repairs, there is no combination code for a vaginal hysterectomy combined with an abdominal enterocele repair; however, OBGYNs should generally avoid performing this combination anyway.
Hysterectomy Scenario
How should you code a vaginal hysterectomy for a uterus weighing less than 250 grams without the removal of tubes or ovaries, including enterocele repair and colpourethrocystopexy?
Answer: You have two coding options.
- Option 1: You can report the vaginal hysterectomy with enterocele repair using 58270. For the simple anterior vesicourethropexy, use 51840 (Anterior vesicourethropexy, or urethropexy [e.g., Marshall-Marchetti-Krantz, Burch]; simple). The National Correct Coding Initiative (NCCI) allows you to report this combination of codes, which may enhance your chances of reimbursement.
- Option 2: Alternatively, you could report the vaginal hysterectomy with colpourethrocystopexy using 58267 (Vaginal hysterectomy for a uterus weighing 250 grams or less; with colpo-urethrocystopexy [Marshall-Marchetti-Krantz type, Pereyra type] with or without endoscopic control) and the vaginal enterocele repair as 57268 (Repair of enterocele, vaginal approach [separate procedure]).
According to the Medicare Physician Fee Schedule (MPFS), the work relative value units (RVUs) for 58270 are 15.30, and for 51840, they are 11.36, totaling 26.66 RVUs. For the second option, 58267 has 18.36 RVUs, and 57268 has 7.57 RVUs, resulting in 25.93 RVUs. Based on these RVU values, the first option is the more advantageous for reporting.
Why BillingFreedom Is Your Top Choice for Hysterectomy Combo Claims Coding?
BillingFreedom is the leading ob/gyn medical billing company specializing in hysterectomy combo claims coding. Our expertise in accurately coding complex procedures, including vaginal hysterectomies with enterocele repair and colpourethrocystopexy, ensures optimal reimbursement for practices. We have successfully avoided OBGYN claim denials. We navigate the intricacies of coding options, such as using 58270 and 51840, or 58267 and 57268, to maximize work RVUs. With a 96% acceptance rate and a commitment to transparency, we reduce accounts receivable days and denials, maintaining a 99% customer retention rate.
Trust BillingFreedom for expert coding that enhances your practice's revenue cycle efficiency in OBGYN medical billing services.
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