Wiki cpt code 58340

[Pebbles1218]

I am trying to help someone that had a procedure done and her physicians office used code 58340S and DX code 256.4. The claim was denied as the physician she uses is a fertility MD. She was pregnant, had a miscarriage and rather than doing a D & C because the physician felt she had a small uterus and it might cause problem for future pregnancy he gave a pill. They did a procedure ( it think ultrasound) and felt they saw something on the uterus so she underwent a sonohysterography to determine what this was. The doctor feels that it is a remnant of placenta that is still there or a calcium deposit. What Dx code could be used to help get this resubmitted and possibly paid as well as reports, letter from MD etc to have it go to audit. DX code 256.4 is for polycystic ovary and she does not know why the physicians office used it as she does not have polycistic ovaries. Any help would be appreciated.....This is out of my expertise as I code General Surgery but am trying to help her get this reconsidered. Thanks

 

[gost]

Has she contacted her physician's office to see if they are appealing the denial? They may already be correcting the claim and resubmitting.

What was the reason for the denial? We know the dx does not exactly match the proc but was that the reason it was denied? It could have been denied for another reason that is easier to correct.

Of course, the codes depend on the physician's documentation. Absent that, we can only guess. If the documetation supports the calcification, 621.8 could be used. If it is a placenta remnant, the miscarriage code would be used, probably 632.

Hope that is some help.