Ob-Gyn Coding Alert

Question: My ob-gyns op note states the following:

1. Hysteroscopic resection of polypoid endometrial lining

2. Hysteroscopic resection of submucosal myoma

3. Endometrial ablation

4. Dilation and curettage

5. Pudendal block.

Can I report 58561 and 58563 together? Do I need a modifier?

Connecticut Subscriber

Answer: Because the Correct Coding Initiative (CCI) does not bundle 58561 (Hysteroscopy, surgical; with removal of leiomyomata) and 58563 (... with endometrial ablation [e.g., endometrial resection, electrosurgical ablation, thermoablation]), you can report the codes together using modifier 51 (Multiple procedures).

Since no CCI edit exists on the code pair, you should not use modifier 59 (Distinct procedural service). You should use this modifier only when another modifier is not more appropriate. In this case, modifier 51 is appropriate.

While you wont receive reimbursement for a pudendal block from Medicare, a commercial insurer may pay for it.

If the ob-gyn performed these procedures in a facility and if you decide to bill the block, you would report 64430 (Injection, anesthetic agent; pudendal nerve) and include modifier 47 (Anesthesia by surgeon) on your primary procedure code (58561). If the ob-gyn performed these procedures in the office (place of service 11), you would list the ablation code (58563) as the primary procedure. Insurers value this code more to account for the equipment used and owned by the practice.

Watch out: You should not report 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C) with 58563. You should consider the dilation and curettage (D&C) bundled into the endometrial ablation. Even though the ob-gyn removed a polyp in addition, you are billing for the fibroid removal -- a more extensive procedure.