Coding, Classification and Reimbursement

CPT Bundling

  • 1.  CPT Bundling

    Posted 11-01-2018 20:56
    Hello Everyone,
    My colleagues and I are trying to resolve a coding bundling issue between CPT 58940 and 58805.  We have a scenario where the patient's Rt ovary was removed and the Lt ovary was drained.  Both code descriptors say unilateral or bilateral.  In this case would the 58805 be separately billable with a 59 modifier?  Any insight would be greatly appreciated.
    Thank you,
    Andrea H.

  • 2.  RE: CPT Bundling

    Posted 11-02-2018 08:19
    The NCCI edit has a 0 modifier, so the two codes can never be reported together, even with a modifier.  You can only report 58940, even though the procedures were done on different ovaries.

    Kristi Pollard, RHIT, CCS, CPC, CIRCC
    Senior Coding Consultant and AHIMA-Approved ICD-10-CM/PCS Trainer
    Haugen Consulting Group

  • 3.  RE: CPT Bundling

    Posted 11-02-2018 09:03
    ​I would use the -XS modifier - separate structure

    Susan Roehl

  • 4.  RE: CPT Bundling

    Posted 11-19-2018 23:46
    Thank you for taking the time to respond.  I found an article regarding CCI on the American Congress of Obstetricians and Gynecologists (ACOG) website which noted the information below.  I believe it is unlikely any major payer would reimburse for the 2nd procedure because the 58940 is a bilateral procedure however, it is worth the attempt.  An appeal would have to include the supporting documentation/article from the professional organization.

    From the ACOG Website:

    Different Sides of the Body
    For example, code 58805 (drainage of ovarian cyst, abdominal approach) is bundled into 58940
    (oophorectomy). These are sequential procedures, and therefore bundled. It is assumed that the
    procedures were performed on the same organ, same side of the body.
    If the drainage of the cyst was performed on the right ovary and the oophorectomy was performed
    on the left ovary, both codes are reported. Use modifiers LT and RT on the codes.

    Thanks again!

    Andrea H-CCS