Q I performed laparoscopic evaluation of a patient with pelvic pain who came to the emergency room (ER). The woman was found to have both a hemorrhagic ovarian cyst, which was cauterized, and appendicitis, for which an appendectomy was performed. What are the rules for billing these procedures together?
A Were you called for a consultation in the ER? If so, bill an outpatient consultation code with modifier -57 (decision to do surgery), as this was the visit at which surgical intervention was deemed necessary. (I assume the procedure was performed either the day of or the day after the decision.)
If no consultation was requested, use an outpatient code for the service, again with modifier -57. If the ER physician is billing for an ER service, you should not do so.
As for the surgery itself: For the cyst cautery, use 58662 (laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method); for the appendectomy, use 44970 (laparoscopy, surgical, appendectomy) with modifier -51 (multiple procedure). You can bill these together, as a different diagnosis supports each procedure and the appendectomy was not incidental.
If you assisted on the appendectomy, still bill codes 58662 and 44970, but add modifier -80 (assistant surgeon) to the latter code.