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Ob-Gyn Coding Alert

Beware of Unbundling When Reporting Hysteroscopies

" From the Ob-Gyn Coding Alert
Extra Supplement on Endoscopic Procedures Although coding for hysteroscopies when the ob-gyn performs them with other services can present any number of problems, you can avoid them by paying close attention to CPT definitions and bundling rules. Hysteroscopy is the oldest gynecologic endoscopic procedure and one of the most frequently performed for ob-gyns, according to CMS.

Hysteroscopy has many indications" including diagnosis of recurrent abnormal bleeding repetitive spontaneous abortion uterine synechiae and infertility " says Toni Revel CPC a coding expert and nurse practitioner based in Warrington Pa. By inserting the hysteroscope a thin telescope-like lighted viewing instrument through the vagina and cervix the ob-gyn can view the uterus she explains. If he or she detects areas of bleeding the doctor can use the scope to destroy the tissue by laser beam electric current or cutting away and removing it at the same time. Reporting Hysteroscopy and LaparoscopyAlthough hysteroscopies may be performed alone ob-gyns frequently do them as part of a larger service to address a patient's condition(s). Such situations often lead to coding questions that you can resolve by carefully reading CPT guidelines and code descriptors.For example an ob-gyn performs a diagnostic hysteroscopy and laser ablation of endometrial implants through the laparoscope and a chromotubation. The physician also uses the laparoscope to remove two subserosal fibroids on the surface of the uterus and eliminates other small fibroids with the laser. To report the laparoscopic removal of the fibroids you should use 58551 (Laparoscopy surgical; with removal of leiomyomata [single or multiple]). For eliminating the endometrial implants report 58662 (Laparoscopy surgical; with fulguration or excision of lesions of the ovary pelvic viscera or peritoneal surface by any method). You should append modifier -51 (Multiple procedures) to 58662.

You can then code for the diagnostic hysteroscopy but you may have to add modifier -59 (Distinct procedural service) to 58555 (Hysteroscopy diagnostic) if the payer bundles hysteroscopies into laparoscopies. " Code 58555 is a separate procedure and may not be paid by many third-party payers when reported with other major procedures " Revel says. Appending modifier -59 to 58555 indicates to the carrier that it is a distinct separate procedure she adds. You may bill the chromotubation with 58350*-51 (Chromotu-bation of oviduct including materials) if the chromotu-bation's purpose was to diagnose a problem of tubal patency rather than to check that the other surgical procedures had not interrupted patency e.g. checking to be sure that sutures have not closed off the oviducts. Generally carriers will reimburse the chromotubation as long as the ob-gyn did not perform it to check his or her work. Note: CPT 2003 deletes 58551. When reporting this procedure after Jan. 1 [...]

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