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Coding questionFrom: K Dew (kdew@bellsouth.net)Wed Nov 1 14:23:55 2000
If any of you listers would be so kind as to help here. Last week I did a TAH-BSO on a 42 year old G4P4 with an 18 week uterus (after Lupron no less!) She is 4'9", 200 pounds. I had to really struggle with this case and ended up needing to do a myomectomy before I could even approach the round ligaments. Making a long story short I needed to take this uterus out piecemeal, and to my horror, I needed to leave the cervix in because I simply could not reach even with the long instruments. (this lady, at appropriate weight, would be about a size 1, really narrow pelvis) I feel that the complexity of the surgery necessitates more than the simple coding for TAH-BSO but not sure how to do it we have 58180 (sub-total hyst) and -22 modifier requesting 40% above usual fee for the hyst and plan to use also 58140 with -59 modifier for the myomectomy as it was a distinct procedure due to unusual circumstances. any comments (including flames) appreciated Kevin Dew, MD OB/GYN Bardstown, KY
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