Reimbursement Advisor

Does morcellation change hysterectomy coding?

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Q My physician performed a laparoscopic supracervical hysterectomy with morcellation. Would I bill 58550-52?

A This question has 2 parts: how to bill for a laparoscopic supracervical hysterectomy, and how to account for the morcellation.

Currently, no code exists for laparoscopic supracervical hysterectomy. Your proposed choice, 58550-52 (laparoscopy surgical; with vaginal hysterectomy for uterus 250 grams or less; reduced service), is sometimes used, but payers just as frequently accept unlisted code 58578 (unlisted laparoscopy procedure, uterus). The latter option, with documentation, sometimes results in prompter and fairer reimbursement over the -52 modifier option. The reason: The procedure is more completely described via the submitted documentation, and payers are less likely to reduce their allowable, even though the cervix was left in place.

When morcellation of the uterus is performed, however, the situation changes: This technique is performed to shred and extract a very large uterus, and CPT has a code (58553) for laparoscopic vaginal hysterectomy for a uterus weighing more than 250 g. Thus, your options would be to bill either 58553-52 or the unlisted code 58578.

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