Coding Resources
Special thanks to Dr. Jennifer Bercaw-Pratt for providing the following coding resources:
How to maximize billing and coding for PAG Presentation (Jennifer Bercaw-Pratt, MD, Angela Hernandez, MD, and Lisa Moon, MD)
Coding Tips (Jennifer Bercaw-Pratt, MD)
Procedure Modifier Codes
|
Modifier
|
Description
|
|
-22
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Increased procedural services (intensity, time, technical difficulty, etc)
|
|
-25
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E/M above and beyond the usual pre- and post-procedure care
|
|
-57
|
E/M service resulted in initial decision to perform major surgery
|
|
-50
|
Procedure done bilaterally (used with codes that are typically unilateral)
|
|
-51
|
More than one procedure performed at the same session (procedures not typically bundled)
|
|
-53
|
Aborted procedure
|
|
-59
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Unusual circumstances involving multiple procedures performed (typically procedures that are bundled)
|
|
-80, or -82
|
Assistant at surgery (depends on teaching hospital/Medicare status)
|
|
-62
|
2 primary surgeons (2 op reports required)
|
|
-78
|
Unplanned return to the OR, complication requiring return to the OR
|
|
-58
|
Staged or related procedure during the global period
|
|
-24, or -79
|
Unrelated E/M or procedure during the global period that is independent of original procedure
|
PAG Procedures
What code do you use? Here’s some of ours:
Vaginoscopy
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
57452
|
Colposcopy of the cervix including upper vagina
|
1.5
|
0
|
Labiaplasty for labia minora hypertrophy
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
56620, -50
|
Vulvectomy simple, partial
|
7.53
|
90
|
Torsion of adnexa (no cystectomy)
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
49320
|
Diagnostic laparoscopy with or without collection of washings
|
5.14
|
10
|
|
58679
|
Unlisted laparoscopy procedure
|
|
|
Laparoscopic aspiration of ovarian cyst
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
49322
|
Laparoscopy, surgical; with aspiration of cavity or cyst [single or multiple]
|
6.01
|
10
|
Laparoscopic paratubal cystectomy
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
58662
|
Laparoscopic, surgical; excision of lesions of the ovary, pelvic viscera, or peritoneal surface
|
12.15
|
90
|
Laparoscopic salpingo-oophorectomy
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
58661
|
Laparoscopic, surgical; with removal of adnexal structures
|
11.35
|
10
|
Laparoscopy for endometriosis
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
49320
|
Diagnostic laparoscopy with or without collection of washings
|
5.14
|
10
|
|
49321
|
Laparoscopy, surgical; with biopsy (single or multiple)
|
5.44
|
10
|
|
58662
|
Laparoscopic, surgical; fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface
|
12.15
|
90
|
- Per AAGL recommendations, if minimal work is involved, use 49320 or 49321. If operative time is ~80 minutes, use 58662. If >80 minutes, use -22 modifier.
Imperforate hymen
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
56700
|
Partial hymenectomy or revision of hymenal ring
|
2.84
|
10
|
Excision of longitudinal septum, transverse septum
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
57130
|
Excision of vaginal septum
|
2.46
|
10
|
- Consider modifier -22 for complicated procedures – transverse septum
OHVIRA repair
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
57130, -22
|
Excision of vaginal septum
|
2.46
|
10
|
- Definitely add modifier -22 for complicated procedure, consider adding 57291 for construction of artificial vagina (no graft)
Lower vaginal atresia repair
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
57291
|
Construction of artificial vagina; without graft
|
8.64
|
90
|
- If using a graft, then can use 57292 – construction of artificial vagina; with graft
Removal of Mullerian remnant
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
58541
|
Laparoscopic, surgical, supracervical hysterectomy, for uterus 250g or less
|
12.29
|
90
|
- If small, consider using code 58661 (removal of adnexal structures)
- If large, code as supracervical hysterectomy
Transposition of the ovary
|
CPT code
|
Procedure description
|
wRVU
|
Global
|
|
58825
|
Transposition, ovary(s)
|
11.78
|
90
|
PAG ICD-9-ICD-10 Crosswalk Table
From ACOG:
https://www.acog.org/About_ACOG/ACOG_Departments/Coding
Free online medical coding reference tool- www.ICD10Data.com
Centers for Medicare and Medicaid Services (CMS)- http://www.cms.gov/ICD10
National Centers for Health Statistics (CHS [CDC])- http://www.cdc.gov/nchs/icd/icd10.htm
American Health Management and Information Association (AHIMA)- http://www.ahima.org/icd10/
AAPC- http://www.aapc.com/icd-10/
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