Ob-Gyn Coding Alert

Question: The doctor stopped the Essure procedure he was performing in our office. According to his documentation, he couldn't visualize due to uterine distention. He said that he did a diagnostic hysteroscopy and then ended up inserting a ParaGuard. He also said that nothing he did for the Essure procedure would be included in the ParaGuard. I've checked the Correct Coding Initiative (CCI) edits, and they are not bundled. How should I report this? Should I apply modifier 53?

Kentucky Subscriber

Answer: At best, you can report 58565-52 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants; Reduced procedural services) and 58300 (Insertion of intrauterine device [IUD]) with either modifier 51(Multiple procedures) because the ob-gyn performed this service at the same time as the hysteroscopy or modifier 59 (Distinct procedural service) because this service was distinct from the Essure attempt.

Alternatively, you could try billing a diagnostic hysteroscopy (58555, Hysteroscopy, diagnostic [separate procedure]) with 58300 and see what happens. That clearly represents exactly what the ob-gyn did.

Don't forget J7300 (Intrauterine copper contraceptive) for the ParaGuard IUD supply.

Error averted: Modifier 53 (Discontinued procedure) does not apply, because the ob-gyn went on and did another procedure.