Optimize Your Gynecological Surgical Coding and Billing for Better Reimbursements

Gynecological Surgery physicians’ offices must have an in-depth knowledge of surgical coding and billing guidance. Often gynecological coding involves the usage of “unlisted” codes for difficult or “outside the box” surgical techniques that do not have a current CPT® code. Correct coding knowledge, as well as documentation macros are useful for implementing better documentation into the medical and patient care records, and better documentation is essential for correct claims.

Understand what’s included in the Global Surgical Package

Services to include in the global surgical package depend on the payer of a particular claim. However, the global surgical package is defined in CPT as including:

  • Local infiltration, metacarpal/ metatarsal/ digital block or topical anesthesia
  • One related E/M encounter on the date of the procedure (including history and physical) or one day before, once the decision for surgery is made
  • Immediate postoperative care
  • Writing orders
  • Evaluating the patient in the post-anesthesia recovery area
  • Typical postoperative follow-up care

On the other hand, CMS has its own Medicare surgical package, as it doesn’t follow CPT guidelines. This includes:

  • Pre-op visits for the day before surgery for 90 day global and day of surgery for 0-10 global
  • Complication following the surgery
  • Post-op visits (related to recovery from procedure)
  • Post-surgical pain management provided by surgeon
  • Supplies
  • Miscellaneous services (dressing changes, staple, drain, tube removal, local incision care, etc.)

When contracting with private payers, find out whether they follow CPT or Medicare guidelines.

Use Modifiers and Unlisted Codes with Gynecological Surgery

Ob-Gyns often see patients with multiple conditions or problem reports. For patients within a global period, bill including modifiers to indicate special circumstances, as the absence of a modifier will result in the intervention being bundled into the global and you not being paid for it. The two-digit codes that are modifiers make a huge difference, as they provide critical information to payers. Modifiers indicate that a service or procedure has been altered by some specific circumstance, without changing the definition or code.

Modifiers 22, 57, 58, 78, 79 can all be used with GYN surgery. For example, Modifier 58 is defined as staged or related procedure or service by the same physician during postoperative care. On the other hand, Modifier 78 is defined as unplanned return to the operating / procedure room by the same physician following initial procedure for a related procedure during the postoperative period. Modifier 79 is defined as unrelated procedure or service by the same physician during the postoperative period.

With the use of Modifier 58, document the staged relationship to the original surgery in the medical record. However, there is no requirement to know the necessity or the date of the subsequent surgery on the day of the original surgery. Modifier 58’s definition includes the term anticipated to allow physicians to anticipate the potential for subsequent procedures without necessarily predicting it.

Modifiers are intended to communicate specific information about a certain service or procedure that is not already included in the code definition. Modifiers are not intended to be used to report services that are “similar” or “closely related” to a procedure code. In situations where no code or combination of codes or modifier(s) will accurately report the service performed, provide written documentation and use the unlisted code closest to the section which resembles the type of service provided to report the service.

For Ob-Gyn practices, knowledge of CPT®, ICD-10-CM and ACOG guidelines and documentation criteria is essential for compliant and correct coding and billing. For more information on navigating gynecologic surgeries with new surgical technologies and techniques, current know-how, time-saving tips, documentation “macros”, proven strategies to help implement better documentation into the medical and patient care records, the usage of “unlisted” codes for some of those difficult and “outside the box” surgical techniques that do not have a current CPT® code, check out this webinar from expert Lori-Lynne A. Webb.

One thought on “Optimize Your Gynecological Surgical Coding and Billing for Better Reimbursements”

  1. Susan Garcia says:

    I need your assistance looking for Modifier for
    87210- to Bill Medical & modifier for 81000-, also bill Medical.
    Also billing for 76856-26 (ultrasound) to Medical.
    I work for a Gynecologist, In California.

    Thank You
    Susan Garcia MA/ Manager

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