Ob-Gyn Coding Alert

Question: One of our providers performed a hysteroscopy dilation and curettage for removal of a uterine polyp and a hymenectomy for a tight hymen. We billed 58558 and 56700 with modifier 51. But the insurance company denied 56700, so we tried sending it with modifier 59. They are still denying 56700, saying it is an integral part of 58558. Are they correct?

Montana Subscriber

Answer: Although you won't find these codes bundled by the Correct Coding Initiative (CCI), you'll find that many payers will consider the hymenectomy (56700, Partial hymenectomy or revision of hymenal ring) as part of the surgical approach of the hysteroscopy (58558, Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C) and therefore bundled. Access to perform the hysteroscopy involves going through the vaginal canal, which means getting past the hymen.

Look closer: Was the patient complaining of a tight hymen in advance of the procedure? Did your ob-gyn document this? If so, you could make a case with the payer that the hymenectomy is a separate procedure for a separate presenting problem. If not, the hymenectomy makes the procedure slightly more difficult to perform but is still integral to approaching the operative site.

Another tactic: Consider attaching modifier 22 (Increased procedural services) to 58558 if the hymen removal involved significant work.