Ob-Gyn Coding Alert

Question: My ob-gyn performed the following procedure: Hysteroscopy dilation and curettage (D&C) with a diagnosis of menorrhagia and irregular menses, a diagnostic laparoscopy for the evaluation of the uterine perforation, and an exploratory laparotomy with repair of the uterine perforation.How should I report this?

Colorado Subscriber

Answer: If this was a Medicare patient, you can bill nothing extra when the surgeon fixes a problem he created.

Other payers may reimburse, but you should look at why the ob-gyn could not repair the uterus via the laparoscope. This means you would report only 58520 (Hysterorrhaphy, repair of ruptured uterus [nonobstetrical])-- that is, if you are able to report this at all.

Watch out: Because your note describes a converted procedure, you should not report diagnostic code 49320 (Laparoscopy, abdomen, peritoneum, and omentum,diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) and the surgery code 58520. That is, the ob-gyn converted the procedure's diagnostic part to an open procedure once the ob-gyn found the problem. As for your diagnosis code, you should report 998.2 (Accidental puncture or laceration during a procedure).