58661 unilateral or bilateral?

Hi,

I have a CPT Assistant article that says that 58661 describes a unilateral procedure. The article goes on to say that if bilateral removal of ovaries and/or fallopian tubes is performed we should append the modifier 50 to indicate a bilateral procedure. Do any of you bill this way and, if so, what has your reimbursement experience been?

Medicare does not recognize the 50 modifier with this procedure.

Thanks for your input!
Donna Cuifolo, CCS-P
Jamestown Area Medical Associates

58661 unilateral or bilateral

When I look in my coding editor, it says:

Special rules for multiple endoscopic procedures apply.
Base code: 49320

and:

0 - 150% payment adjustment for bilateral procedures does not apply.

Does that make sense? How old is the CPT Assistant article?

58661

I would say code 58661 is a unilateral code so modifier -50 is appropriate if bilateral. Some may differ in their interpretation.

58661 Unilateral or bilateral

The CPT Assistant article is from January 2002. I think it is unilateral and I think if it was meant to be bilateral the description would read something like: Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomies and/or salpingectomies) (plural instead of singular). I think it is being misread because it says partial or total. It also makes things confusing when Medicare does not recognize this code as being unilateral. They will not allow a 50 modifier and have a MUE of 1 unit attached to this code. I had a claim deny once because a Medicare beneficiary had previously had one ovary removed (while she was on Medicare) and then a few years later had the other ovary removed. The denial stated something like lifetime maximum has been reached.

Now, when you look at procedures for orchiectomy (54522) the bilateral modifier is allowed and there is a MUE of 2. I guess the ovaries are considered one unit and the testes are considered 2! These things really puzzle me sometimes.

Thank you for your input.