Wiki Cold knife cone biopsy with ECC hysteroscopy with uterine perforation, laparoscopy with cautery of uterine fundus

[TanBro]

Cold knife cone biopsy with ECC, hysteroscopy with uterine perforation, laparoscopy with cautery of uterine fundus. Can someone tell me if I'm thinking correctly on this? I'm thinking codes 57520, 58520, and 58578 with comparison to code 58540. Diagnosis is adenocarcinoma in situ of the cervix. PLEASE HELP!! If need more info, please let me know. Thanks in advance!

 

[Cmama12]

Hi Tanya, more info would be good. It sounds like the uterus perforation was caused by the doctor, in which case you can't bill for the repair. 57520 is correct for the cold knife cone.

 

[TanBro]

Hi Tanya, more info would be good. It sounds like the uterus perforation was caused by the doctor, in which case you can't bill for the repair. 57520 is correct for the cold knife cone.

Yes, I believe it was too but because it was very thin. Should I still not charge for it?

Procedure detail:
A dilute vasopressin solution was injected around the circumference of the cervix. 0 Vicryl Sutures were placed at 3 and 9 o'clock. The cone segment was excised and marked at 12 o'clock. An ECC was obtained. Following this, the cervix was prepped. A uterine sound met no resistance and went through the uterine fundus. No abnormalities were observed. Hysteroscope removed.
Repositioned, the abdomen was insufflated, and the patient was placed in Trendelenburg. The cesarean scar site was intact. There was a small perforation at the uterine fundus was soft to the left of midline. This has a small amount of bleeding present. No adhesions. Both tubes and ovaries appeared to be within normal limits. A 5 mm trocar was placed suprapubically under direct visualization and bipolar cautery was used to cauterize the perforation site. Arista placed.

Thank you so much for taking the time to help me. I appreciate it!

the more I think about it I think I was wrong. Would it be 57520 and 58558?

 

[csperoni]

So this procedure detail leaves me with some additional questions and is not really all that detailed.
1) Yes, I agree with 57520 for the cold knife conization.
2) Why were they sounding the uterus in the first place? Was another procedure planned?
3) States hysteroscope removed, but when did they insert? Is it inserted with the sound?
If they planned and performed the hysteroscopy for a medical reason (not just because of an intraop injury or potential injury), then likely also 58558. Any additional procedure performed by the same physician/group to check for or repair an injury caused by another procedure would not be billable. If a separate physician/group was called in to perform an additional procedure, the external physician may bill for their services.

EDITED to clarify if same physician performs additional vs external physician.

 

[TanBro]

So this procedure detail leaves me with some additional questions and is not really all that detailed.
1) Yes, I agree with 57520 for the cold knife conization.
2) Why were they sounding the uterus in the first place? Was another procedure planned?
3) States hysteroscope removed, but when did they insert? Is it inserted with the sound?
If they planned and performed the hysteroscopy for a medical reason (not just because of an intraop injury or potential injury), then likely also 58558. Any procedure performed to check for or repair an injury caused by another procedure would not be billable.

I agree with the detail. The Hysteroscopy was planned due to colpo showed adenocarcinoma in situ of the enodcervix. Thank you so much for explaining things to me.