OB/GYN Coding Rules for Reporting Bowel Excision in Endometriosis Cases

Endometriosis surgery is hard to code when more than one site is involved. A surgeon may excise endometriosis from the peritoneum within the pelvis and also cure a lesion that is associated to the bowel. But seeing a patient with two sites of endometriosis is not sufficient to support separate reporting. The distinction is whether the bowel surgery is considered a separate surgical procedure or is a part of the main peritoneal surgery. 

Can Both Procedures Be Reported for Pelvic and Bowel Endometriosis?

Question: For a patient with severe endometriosis, the surgeon excised endometriosis from the pelvic peritoneum and also removed a separate endometriotic lesion involving the bowel. Can both procedures be reported, or is the bowel excision considered part of the peritoneal endometriosis excision?

Review the Operative Report Before Reporting Separate CPT® Codes

Answer: Depends on the specific surgical service performed, which is detailed by the surgeon, and whether the bowel procedure is an independent surgical service. In reviewing the operative report, do not assume that if another site of endometriosis is mentioned, that this automatically qualifies to report another CPT® code. 

Determine the Surgical Work Performed

Your first step is to determine what work was actually performed.

Identify Whether the Bowel Procedure Is Distinct

If the surgeon excised endometriosis from the pelvic peritoneum and separately performed a distinct bowel procedure, such as a partial colectomy for deeply infiltrating bowel endometriosis, you may be able to report both procedures if each is separately identifiable and medically necessary.

Check NCCI and Payer Bundling Rules

Check the current National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edit tables and any payer-specific bundling rules prior to coding both CPT® codes. 

Confirm Edits for the Date of Service

Because NCCI edits are updated quarterly, always confirm code relationships based on the date of service.

Determine Whether a Modifier Is Supported

If an edit exists, determine whether it allows reporting with an appropriate modifier, such as modifier 59 (Distinct procedural service) or an X{EPSU} modifier, when documentation supports a truly distinct procedural service.

What This Means for Your Practice

• Before billing two codes, read the operative note for a separate bowel procedure, not a second site of disease.
• Check the NCCI PTP edit for that exact date of service. The tables change quarterly and the edit that applied last quarter may not apply now.
• When you use modifier 59 or an X modifier, record in the claim note what in the documentation supported it. That is the file you will want in an audit.
• If a general or colorectal surgeon performed the bowel resection, settle who bills it before the OB/GYN claim goes out.

How BillingFreedom Can Help

BillingFreedom can also assist OBGYN practices with OBGYN medical billing services to examine operative documentation, and determine if there are additional procedures that can be billed separately. Its coding workflow also provides the ability to review NCCI edits, payer specific bundling needs and documentation for appropriate modifier usage. 

This coding review is useful for endometriosis and cases with pelvic and bowel surgeries to be sure the claim is based on the documentation of services performed, not the number of anatomical sites only. 

To learn more about our outstanding medical billing services, you may not hesitate to get in touch with us through email at info@billingfreedom.com or by phone at +1 (855) 415-3472. 

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