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

Increased procedural services (intensity, time, technical difficulty, etc)

-25

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

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/