Wiki GYN surgery question

[Christy277]

My provider performed a hysteroscopy with ablation, a Myosure polyp removal, and a D&C at an outpatient ambulatory surgery center for abnormal uterine bleeding and endometrial polyp.
Would I code it as 58563, 58561, and 58120, 59? OR would I code it as 58563 only? HELP!
Thanks!

 

[Cmama12]

Hi, 58561 is for removal of a fibroid. I am assuming you meant 58558 for a polyp. In short, you can only code the 58563.
A D&C is part of 58558 and 58558 bundles with 58563. Even if the D&C was done without the polypectomy, you would still not code it separately.

 

[Christy277]

Thank you!
I see that 58120 is a column 2 code for 58563, so I could use a modifier to override the edit. What would be the "appropriate circumstances" to do this?

 

[nickelclaw]

Myo-sure is 58558 and like mentioned above D&C is included you will only code this. May also use tool or be called Tru-clear.

58563 is Minerva, Novasure (tool name) ablation

58565 is Essure

 

[nielynco]

Thank you!
I see that 58120 is a column 2 code for 58563, so I could use a modifier to override the edit. What would be the "appropriate circumstances" to do this?

No. An endometrial ablation scrapes the lining of the uterus and so does a D&C which is why they are bundled.

 

[brookepoole1985@yahoo.com]

I have a question. My provider performed a Hysteroscopy w/ Polypectomy. I only reported cpt 58558, as noted in the OP note. BCBS has denied the claim stating "Procedure billed with wrong modifier or missing modifier". I didnt bill with a modifier because I didn't think one was needed. I am a newly certified coder and still a bit unsure of myself. Does this need a modifier? I appealed with OP notes, but the denial is still being upheld. Any suggestions?

 

[csperoni]

I have a question. My provider performed a Hysteroscopy w/ Polypectomy. I only reported cpt 58558, as noted in the OP note. BCBS has denied the claim stating "Procedure billed with wrong modifier or missing modifier". I didnt bill with a modifier because I didn't think one was needed. I am a newly certified coder and still a bit unsure of myself. Does this need a modifier? I appealed with OP notes, but the denial is still being upheld. Any suggestions?

Is the patient in a global period of another surgery? Was it the same day as an E/M service? Was there a resident involved in the surgery? Was the service somehow reduced?
Typically 58558 would not require a modifier, but if there were other circumstances (like the examples above), it is possible a modifier is needed.
It is also possible BCBS is incorrect.
I would suggest carefully reviewing the circumstances to see if a modifier would be appropriate, and if not, reach out again to BCBS. When you appealed, did you simply send the op notes or did you also submit a letter?