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Asherman's Syndrome; Hysteroscopy and laparoscopy (J.M. DOS 102715)

Sandra Posted Mon 04th of January, 2016 17:36:23 PM

How do I bill:
1. Operative Hysteroscopy
2. Resection of endometrial scar tissue
3. Operative Laparoscopy
4. Ablation of endometriosis
5. Chromopertubation
DX: Asherman's Syndrome
Endometriosis, Stage I

SuperCoder Answered Tue 05th of January, 2016 03:34:11 AM

Appropriate CPT codes for this scenario would be:

58563 Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)
58350-51 Chromotubation of oviduct, including materials
Diagnosis codes would be:
N85.6 Asherman's Syndrome
N80.9 Endometriosis

Sandra Posted Tue 05th of January, 2016 12:08:31 PM

But what about the laparoscopy?

SuperCoder Answered Wed 06th of January, 2016 04:44:54 AM

We can code laparoscopy only if there is diagnosis for which laparoscopy is done. In this scenario diagnosis are Asherman's Syndrome and Endometriosis which are payable for hysteroscopy. So in this case, laparoscopy will not be codable.

Sandra Posted Wed 06th of January, 2016 13:57:09 PM

The operative report states they did both, Hysteroscopy revealed a thick midline septum. Only the right corneal region was able to be visualized and right periosteal scar tissue was noted. Smith & nephew TruClear morcellator was utilized to resect to the thick midline adhesion and right periosteal adhesions. This revealed a normal-appearing left ostium, but unable to visualize the right ostium. Operative Laparoscopy revealed patent left tube on chromotubation, but no fill of the right tube consistent with proximal obstruction. There were three powder-burn lesions on the left posterior left cul-de-sac consistent with stage 1 endometriosis, which were ablated with blunt dissection. The remainder of the pelvis, ovaries, uterus, and upper abdomen were grossly normal.
So Shouldn't I bill for the Laparoscopy some how?

Sandra Posted Wed 06th of January, 2016 17:20:13 PM

perhaps 58578?
So would I bill 58563, 58578 and 58350-51?

Sandra Posted Wed 06th of January, 2016 17:50:45 PM

Can I send you the operative report some how? Am thinking cpt code 49321 for laparoscopy.

SuperCoder Answered Thu 07th of January, 2016 02:20:55 AM

Thanks for details.
It is clear from above documentation that operative laparoscopy is done for chromotubation only as chromotubation is a procedure in which physician injects a liquid dye or solution into the uterine cavity or directly into the fallopian tubes. This procedure is frequently performed during a separately reported surgery, open or laparoscopic, to verify patency of tubes.
So no need to code laparoscopy separately.

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