I am having a debate with a colleague who codes for another doctor. My doctor will sometimes do an Assist with him and we are coding our surgeries differently for the same procedures therefore causing a problem with the insurance reimbursement and denials. I have discussed this with my physician to confirm how he does his Total Vaginal Hysterectomy and he confirms that he uses the laparoscope diagnostically only to determine if the hysterectomy can be carried out vaginally or if he feels it would need to be an open procedure. If he determines that it can be done vaginally, he then proceeds with the surgery and does the entire hysterectomy vaginally. The ACOG guidelines state that in order to code for a Laparoscopy, surgical, with vaginal hysterectomy (58550) "Detachment of entire uterine cervix and body via the laparoscope and vagina" must be done. ACOG further states, "LAVH includes laparoscopically detaching the uterine body from the surrounding upper supporting structures. The vaginal portion of the procedure is then performed." My colleague said she was told years ago by an insurance company that she had to use the 58550 and that the diagnostic scope was bundled. As a result of the ACOG guidelines, I have been submitting Diagnostic Laparoscopy 49320 with Total Vaginal Hysterectomy 58260. The CCI edits do not require a 59 modifier but my Encoder Pro tips suggest that I use the 59 modifier when the Scope is not used as part of the surgical procedures. Some of the insurance companies do question this, but I send the op notes when needed and I am successful with getting this paid. It does take more time, but there is more reimbursement since the scope is not bundled and clearly is being used as a separate procedure. Could someone weigh in on this as to what the proper coding should be. I don't have to be right. I just want to do it right. Thank you so much in advance.