D&C Coding Question

Billing500

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Can someone assist our office in coding the following? Our coder is away and we'd like to submit these claims. Any help is greatly appreciated.

Case# 1
D&C 58558
Laparoscopic Enterolysis 44005 (as a separate procedure)
Diagnostic Laparoscopy
Pt was diagnosed as follows: Irregular Menses, Pelvic Pain, Adhesions, Peritoneal Adhesions
Multiple procedure modifier applicable?

Case# 2
Emergency suction D&C 59820
Emergency uterine evacuation and curettage for Hydatidiform mole 59870
Again, are modifiers necessary here? May we bill BOTH codes?

Thank you,
Betty
 

OCD_coder

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Case #1
There is no bundling per NCCI edits and without looking at the documentation, I always hesitate billing a Separate Procedure with another procedure. As these are viewed as billable usually when only performed as the only procedure in a surgical session. Medicare states in their NCCI Policy Manual that they will not create an edit for all situations where a Separate Procedure is inherent to a more complex procedure in the same anatomical area. But that is not always the case. There is no bundling and modifier 51 would be appropriate on the 2nd CPT surgical code.

Case #2
I am extremely leery of billing for essentially 2 different D&C surgeries at the same encounter. There needs to be more information shared as to what kind of situation you have either a missed abortion (59820) or if there is documentation of a molar pregnancy I (59870) would only bill one or the other. The procedures don't bundle, but they are similar surgical procedures and more information is needed to give you a final answer. See the descriptions of the procedures below to see the similarities.

59820
The physician treats a missed abortion by suction curettage in the first trimester for 59820. In missed abortion, the fetus remains in the uterus four to eight weeks following its death. Ultrasonography may be needed to determine the size of the fetus prior to the procedure. The physician inserts a speculum into the vagina to view the cervix. A tenaculum is used to grasp the cervix, pull it down, and exert traction. A dilator is inserted into the endocervix and through the cervical canal to enlarge the opening. The physician places a cannula in the endocervical canal and passes it into the uterus. The suction machine is activated and the uterine contents are evacuated by rotation of the cannula. After suction curettage, a sharp curette may be used to gently scrape the uterus to ensure that it is empty.

59870
The physician treats a hydatidiform mole (molar pregnancy) by evacuation and curettage of the uterus. The physician inserts a speculum into the vagina to view the cervix. A tenaculum is used to grasp the cervix, pull it down, and exert traction. A dilator is inserted into the endocervix and through the cervical canal to enlarge the opening. The physician places a cannula in the endocervical canal and passes it into the uterus. The suction machine is activated and the hydatidiform mole is evacuated by rotation of the cannula. After suction curettage, a sharp curette may be used to scrape the uterus and confirm that it is empty.
 

Billing500

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Thanks OCD. In case #1, the provider performed an operative laparoscopy (49320 for pelvic mass) and laparoscopic enterolysis, separate procedure 44180 (not 44005). Additionally a D&C (58558) was performed for irregular menses. Can all three codes be billed? Thanks!
 

OCD_coder

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CPT code 44180 is the more comprehensive laparoscopy code and diagnostic lap procedures are always included into these procedures. You cannot report the 49320 separately on the same claim as it is inclusive to the 44180, a modifier is NOT allowed per NCCI edits and CPT guidelines.

The 58558 does not bundle with the 44180, but be sure you have the documentation to support both codes.
 
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