Ob-Gyn Coding Alert

Question: Consider a patient who has dysfunctional (or abnormal) uterine bleeding (DUB) in addition to chronic pelvic pain, but did not have an endometrial biopsy prior to current hysterectomy (because of a low tolerance for pain). Suspicion for endocarcinoma is low. A D&C (58120) is performed at the time of TAH (58150), so the curettings may be sent for frozen sections if there is any suspicion of malignancy. Then we proceed with the TAH, with or without a BSO. Should we, and are we allowed to bill for the D&C?

Spyros D. Kitromilis, MD
Syracuse, NY

Answer: The question to be answered here is whether the D&C is considered to be a diagnostic procedure or whether you planned to do the TAH no matter what the D&C curettings will show. If the TAH is the planned procedure, the D&C should not be reported separately. If your documentation clearly shows that the D&C was diagnostic in nature and more extensive surgery would only be done if the results showed a problem, you can bill for the D&C in one of two ways. Use modifier -59 to show that the D&C was a distinct service, or use modifier -22 to show unusual services. Either way, supporting documentation would need to be submitted with the claim. You would not use a modifier -58 in this instance because this modifier requires that the more extensive procedure be performed on a different day than the first procedure (and of course within the global period of the first procedure).