Diagnostic hysteroscopy w/D&C and Novasure Ablation

[kbarron]

I am having some confusion as to the coding for this. The codes I am reading are confusing. I have not had any formal OBGYN training. I read the op notes and figure out the code with the coding companion. But on this monday morning I can't think. How would I be able to capture all the components without unbundling the codes. MD states diag hysteroscopy D&C and novasure ablation. Thank you for youe help.

[magnolia1]

Unfortuntately, the only procedure you can code here is the ablation.

I equate this scenario to taking a biopsy of a lesion (D&C), and then destruction of what is left of that same lesion (ablation) during the same operative session.

Hope this helps.......

[amjordan]

First, if you are new to OB/Gyn coding I would highly recommend getting the OB/GYN CODING MANUAL: Components of Correct Procedural Coding from ACOG. You can order it from their website www.acog.org .

Now, to answer your question, based on the information you provided you can bill out the 58563. A diagnostic hysteroscopy is included in this procedure. Now the D&C per CCI is bundled with a "1", so it can be unbundled if it is truly a separate procedure. The OP note will have to support that. I will add that most commercial carriers have additional internal edits and the D&C is included, no modifier allowed.

[magnolia1]

The correct CPT for the Novasure Ablation is 58353 (this is not a "hysteroscopic" procedure).

My CCI edits indicate that 58558 (Hystero w/ D&C) cannot be billed with 58353 (even if an appropriate modifier is present).

[kbarron]

I do have the 2009 Coding companion. Is this different from the coding manual? I had the 58563 as the code and was told that the D&C was also done. I was looking to see if it could be coded separately. I have gotten confused with the closeness of the procedures.

[amjordan]

I would review the OP note and see why the D&C was done. If it was done to necessitate the Novasure, don't bill it.

Here is an excerpt from one of the OB/Gyn workshops I went to with Melanie Witt. She used to work for ACOG and is now one of the National authorities on OB/Gyn coding.

No matter how the CPT words the procedures there are only two codes for an endometrial ablation.? 58563 when a hysteroscope is used at any time during the procedure and 58353 when a hysteroscope is not used.? NovaSure with no scope is 58353; NovaSure with a scope is 58563.

Melanie Witt, RN, CPC-OGS, MA

As for the manual, it is a little different and it contains ACOG official comments on several issues that can be used when appealing claims to commercial carriers.

[rebecca lopez]

use 58563 with Hysteroscopy and
58353 W/O Hysteroscopy.

When you read the op notes and it states Novasure you use one of these codes

[kbarron]

Now, pt has the ablation and it did not work. I would think that even though the ablation did not work I could still code for the ablation w/D&C.

[Lisa Bledsoe]

Originally Posted by magnolia1

The correct CPT for the Novasure Ablation is 58353 (this is not a "hysteroscopic" procedure).

My CCI edits indicate that 58558 (Hystero w/ D&C) cannot be billed with 58353 (even if an appropriate modifier is present).

If the surgeon uses the hysteroscopic prior to the Novasure ablation and then again following to view the ablated endometrium, wouldn't you code 58563?

[imjsanderson]

58353 is the ablation without hysteroscopic guidence
58563 is with hysteroscopic guidence

If the physician did a hysteroscopy/D&C(58555) and then an ablation without hysteroscopic guidence(58353) you will want to bill the procedure with highest value, in the case the 58353 has a higher RVU. 58555 is bundled with 58353.

Jamie