Wiki 2 codes for Hysteroscopy w/ Diag. Laparscopy

sfirth1

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Doctor preformed a Hysteroscopy in out patient dept. and was planning to do an endometrial ablation but in the OR the uterus was perforated and an emergent diagnostic Laparoscopy was done. Would Hysertscopy (58555) with a Diag. LAP (49320) be able to be billed together since there were 2 different entry points. I'm asking since they both are marked as "separate procedures" but I don't see any other options. Please help.
 
Doctor preformed a Hysteroscopy in out patient dept. and was planning to do an endometrial ablation but in the OR the uterus was perforated and an emergent diagnostic Laparoscopy was done. Would Hysertscopy (58555) with a Diag. LAP (49320) be able to be billed together since there were 2 different entry points. I'm asking since they both are marked as "separate procedures" but I don't see any other options. Please help.

You would not bill for the 49320 because you would need to bill for the repair (I'm asuming that was done) and the dx lap 49320 would be bundled into the 58678 unlisted code for the hysterorrhaphy. With a comparable to the 58520.
Don't forget to add -58 to the 58555 for the staged procedure on the same day.
 
Doctor stated no repair was needed. He did a diag. lap. to check for any bleeding or problem. Thanks for your help. I will try 58555-58 and 58678.
 
I wouldn't use modifier 58. This modifier is for a staged or related procedure during a postoperative period. Medicare requires a return to the operating room for modifier 58. Was your doctor going to put the patient under anesthesia twice? I am assuming he was going to do a 58563 "hysteroscopy with endometrial ablation" since you state he was planning to do this in the OR (same session) when the uterus was perforated and he had to stop the procedure for an emergent diag. lap. If that is so, a more correct coding option is to use modifer 52(reduced services) with 58563 and modifier 59 with 49320. 49320 may state "separate procedure" but some carriers require the modifier 59.
 
Thanks. You are corrected that patient was already in OR and under anesthesia so 58 isn't corrected. The PA is for 58563 so if I bill it to Peach State w/ modifier 52 then it shouldn't deny with the PA for that code. I was told I would have to appeal after a denial if I had to change the code to 58555.
 
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