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Ob-Gyn Coding Alert

Reader Question:

Laparoscopic IUD Removal With Hysteroscopy? Code This

Question: Please confirm if I can use CPT® 49329 for “laparoscopic removal of an intraabdominal intrauterine device.” The op-report states that “the IUD was found on left upper abdomen near L2.” What can I compare the unlisted code to? The doctor also listed “hysteroscopy” as a secondary procedure, but wouldn’t this be included in the removal?

Minnesota Subscriber

Answer: The answer depends on why he did the hysteroscopy. But yes, you should report a laparoscopic removal of an IUD with 49329 (Unlisted laparoscopy procedure, abdomen, peritoneum and omentum). You should compare the work to 49402 (Removal of peritoneal foreign body from peritoneal cavity).

Note: The hysteroscopy was most likely trying to find the IUD as part of the primary procedure so it would be considered a diagnostic procedure (58555). Had they found it with the hysteroscope they would not have had to move on to the laparoscopy. Medicare rules say code only the successful procedure. AMA guidelines would allow both services to be reported.  

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