Wiki Exam under Anesthesia

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klapetri@ilovemygyn.com

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Physician performed Exam under Anesthesia (EUA) and a vaginoscopy
Vaginoscopy performed to r/o vaginal septum
CPT codes EUA-57410
vaginoscopy-57130

Per AAPC 57410= An exam under anesthesia is bundled into all procedures as the “look–see” during other procedures that involve the female genital system. This code can only be billed when it is the only service provided. When the exam is performed in the office setting, even if the physician must use moderate sedation or a local anesthetic to accomplish any part of the exam, it is part of an E/M service and not billed separately.

Does the vaginoscopy have to get bundled?
can this be performed in other operative scenarios and be not bundled?

Appreciate the feedback
 
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Physician used a hysteroscope but did NOT do a hysteroscopy.
Used an endoscope with saline infusion to visualize the whole length of the vagina to r/o transverse, longitudinal, partial or occult vaginal septum.
No septum found or seen, therefore no septum was excised.
So cpt 57130 would not be used.
Would use 57410(EUA)
57420 mod. 22
Any ideas
Appreciate the feedback
 
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I've never had a physician use a hysteroscope instead of a colposcope in this situation.
To me, you can't use 58555 since he did not examine the uterus. Can't use 57420 since he did not do a colposcopy. 57410 seems like the best (if less than ideal) option.
 
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There is no exact line in the sand when you can bill -22.
From NGS:
Modifier 22 – Increased Procedural Service
Modifier 22 is used to identify procedures which require individual consideration and should not be subject to the automated claims process. A description of the increased services may be entered in the comments field of electronically billed claims, or submitted as an attachment with paper claims. NGS may require additional documentation to support the substantial additional work (for example, increased intensity, time, technical difficulty of the procedure, severity of the patient’s condition, and physical/mental effort required). Documentation includes, but is not limited to, descriptive statements identifying the increased services, operative reports, pathology reports, progress notes, office notes, etc. If additional information is needed, we will request it.

The submission of a procedure with modifier 22 does not ensure coverage or additional payment. All claims with modifier 22 and appropriate documentation are reviewed by medical review staff to determine whether payment is justified.

Modifier 22 can be used on all procedure codes with a global period of 1, 10 or 90 days when unusual circumstances warrant consideration of payment in excess of the fee schedule allowance.

Note the phrase "substantial additional work." I would doubt the op note supports using -22.
 
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