Wiki Hysteroscopy (58558) for Retained Product of Conception

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tloeb

tloeb

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It is becoming very common for our OB/Gyn's to use a hysteroscope to remove possible retained POC after an initial D&C when a patient is presenting for continued bleeding. I sent a question to ACOG sometime ago regarding the best code to use and their response was:

This email is in response to your coding question: Missed AB and retained products of conception via hysteroscope.
The complicating factor in this case is that there is no hysteroscopic maternity code—not even an unlisted hysteroscopic maternity code.

The American Hospital Association’s (AHA) Coding Clinic advises that CPT code 59812 Treatment of incomplete abortion, any trimester, completed surgically, should be used in this case as this code best represents the intent of the procedure (4th Quarter 2021, page 12). The AHA advises against the use of 58558 Hysteroscopy, surgical; with sampling (biopsy of endometrium and/or polypectomy), with or without D & C because the procedure is not consistent with the intent of this code. However, the ACOG Committee for Health Economics and Coding (CHEC) recommends the use of 58558 in this situation because it captures the tools and work associated with the procedure—particularly if the service is provided in an office setting.

I am not having any denial issues using 58558 for retained POC, yet. I am curious how others are billing for these?
Thanks!
 
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We use 58558 for hysteroscopic D&C due to retained POC. We have not had any issues thus far. However, I do have the same ACOG committee meeting you referenced saved for appeal purposes if the need ever arises.
 
I have a situation somewhat similar to this that I am in need of help with as my CFO is looking closely at this issue and I just want to verify if I'm correct in the knowledge/way I have gone about this or if anyone has had a similar situation they could shed some light on this for me.

QUESTION: We have a provider on maternity leave and our other providers are trying to figure out how to collect their portion for seeing these pts while she is on leave. I have a pt that started her OB care w/ us and only had 4 visits total (2 visits routine ob care & 2 billed as problem visits) prior to the pt unfortunately having miscarriage where she (per hospital records) delivered upon arrival to hospital then required D&C for retained placenta. Her last visit was with us on 8/17, then had D&C at outside facility from us on 8/19. I originally opted to not bill the visit we did on 8/17 considering records reflected she was admitted to outside facility the very next day on 8/18 as insurance will often deny visits leading up to surgeries like this. I am being told that I can bill problem visit we seen pt for on 8/17 and just add modifier since the D&C was performed by outside provider. Does this sound correct? Or is there a different way of going about this? TIA!!
 
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