Ob-Gyn Coding Alert

Question: We have a new physician in the practice who wants to start doing hysteroscopy in the office. Can code 58555 be used for an office procedure?

New York Subscriber

Answer: Code 58555 (Hysteroscopy, diagnostic [separate procedure]) is for diagnostic hysteroscopy, and this can be performed in the office. The RVUs (relative value units) for the procedure in the office setting are generally higher due to increased practice expense. However, some payers will not allow a hospital procedure to be performed in the office setting without pre-approval, so you need to find out if any of your payers require this before you bill (e.g., some payers say the procedure can be performed only in a certified ambulatory surgical center, while others require proof that the office is set up for emergencies as a result of the procedure). Also, most payers will not reimburse any kind of facility fee for the procedure when done in the office (like an office surgery room fee, etc.), so you may find that your expenses are generally not being met for this type of service without going into negotiations with the payer for an office surgery fee.