Wiki CPT EXCISION OF PLACENTAL NODULE

[Girlzsmom66]

Good afternoon! I have a physician who has a patient scheduled for a possible excision of placental nodule. She will monitor her hcg level one more time to see if it has dropped significantly from the patient miscarriage. EMB was done and stated there was secretory endometrium with areas of decidualization with degenerative change, suggestive of a prior placental implantation site.

Would CPT 59160 be appropriate for the procedure and N85.8 with N96 be okay to use?

I would appreciate any and all feedback!

Thank you!

 

[nielynco]

Good afternoon! I have a physician who has a patient scheduled for a possible excision of placental nodule. She will monitor her hcg level one more time to see if it has dropped significantly from the patient miscarriage. EMB was done and stated there was secretory endometrium with areas of decidualization with degenerative change, suggestive of a prior placental implantation site.

Would CPT 59160 be appropriate for the procedure and N85.8 with N96 be okay to use?

I would appreciate any and all feedback!

Thank you!

If she is removing a nodule, she is not doing PP curettage so 59160 would not be correct. But is she going to actually remove a nodule or is she going to scrape with uterine lining? 59160 can only be billed following a delivery (after 20 weeks gestation) and the code that would apply for such scraping following a miscarriage would be surgical treatment of an incomplete abortion. Are you trying to get this prior authorized? If you can wait until you have a description of the actual procedure this should help to guide you to the best code. If it turns out to be just the removal of a nodule from the lining of the uterus there will be no code and it would be unusual not to try to remove it under visualization (such as hysteroscopy) which may be one of the closest codes. N85.8 would probably be fine if that is the only reason for performing the procedure, but N96 can only be reported if the patient has met the definition criteria for recurrent pregnancy loss (two or more consecutive failed clinical pregnancies documented by ultrasound or histopathology) and only report it if the procedure is pertinent to that loss.

 

[Girlzsmom66]

If she is removing a nodule, she is not doing PP curettage so 59160 would not be correct. But is she going to actually remove a nodule or is she going to scrape with uterine lining? 59160 can only be billed following a delivery (after 20 weeks gestation) and the code that would apply for such scraping following a miscarriage would be surgical treatment of an incomplete abortion. Are you trying to get this prior authorized? If you can wait until you have a description of the actual procedure this should help to guide you to the best code. If it turns out to be just the removal of a nodule from the lining of the uterus there will be no code and it would be unusual not to try to remove it under visualization (such as hysteroscopy) which may be one of the closest codes. N85.8 would probably be fine if that is the only reason for performing the procedure, but N96 can only be reported if the patient has met the definition criteria for recurrent pregnancy loss (two or more consecutive failed clinical pregnancies documented by ultrasound or histopathology) and only report it if the procedure is pertinent to that loss.

Thank you so much for the insight! There is always something new, always!