Proper Usage of Code 58679

Even with the reams of information and thousands of codes, there are many procedures in which there is no particular medical billing code to represent it. For instance, an Oophoropexy is usually performed for radiation therapy, but what if it were part of a treatment for polycentric ovarian syndrome?

In the oophoropexy example above, some medical billing staff members may use the current procedural terminology code 58825 (Transposition, ovary). Unfortunately, they would be incorrect and would receive most likely a very reduced reimbursement or an outright denial of the medical billing claim. The definition of transposition is when an ovary is moved due to radiation therapy. Since radiation therapy is not being performed, it is not appropriate to use the code in medical billing.

Since there is no specific medical billing code to utilize in this example, an unlisted current procedural terminology code is in order. 58679 (Unlisted laparoscope’s procedure, oviduct, ovary) is the correct code to use in this case. You would need to supply accurate ICD-9 codes and explanatory documentation with your medical billing to back up your claim.

If there is another procedure performed in conjunction with the oophoropexy, however, another policy is in order. You would use the current procedural terminology code of the other procedure, and attach a modifier 22 to the end. This means: Unusual procedural services. An oophoropexy performed for polycentric ovarian syndrome warrants an unusual procedural service. Also be aware that your modifiers no longer need to be preceded by hyphens.

One major rule to remember when doing medical billing is to never report a code that doesn’t completely describe the service you are providing. There is no reason to force a fit if it is not there. If there is no medical billing code to match a procedure, use the unlisted procedure code and provide explanatory documentation with your claim and this should result in receiving the proper reimbursements for your medical billing claims.

View all Articles by: Melissa Clark, CCS-P