Hello, Could use some help as my OB coding is not strong. Have a situation were the patient delivered a healthy baby and is coming back 13 weeks later to the hospital for a D&C for retained products of conception. Coded CPT 59160 but it's being denied. Payor is requesting 58120. They are saying that CPT 59160 is more relevant directly after delivery and during the same episode of care while the cervix is still dilated. My procedure was performed 13 days after delivery and required dilation to open the cervix, per CPT guidelines, the coding change to 58120 should be coded.
Thought the postpartum period was 6 weeks. So wouldn't this still be considered in the postpartum period. Patient had heavy vaginal bleeding & cramping and passing baseball size clots.
Here is the procedure: 2 Sims retractors were paced in the anterior & posterior aspects of the vagina. The anterior lip of the cervix was visualized and grasped with a single-tooth tenaculum. A #10 Hegar dilator was utilized and noted to moved freely through the cervix. A #10 rigid suction surette was then introduced into the uterus and suction was initiated. Suction was continued rotating with outward traction and a large amount of procedures of conception consistent with placental tissue were evacuated from the uterus. Two passes were undertaken. The uterus was noted to be clear on ultrasound. A sharp curette was introduced and a gritty feeling was noted throughout the uterus. Howe, every time a curette was introduced into the uterus, more bleeding was noted concerning for abnormal placentation of some sort. IM Methergine was given. Uterine tone was noted to be good. The cervix was visualized for multiple minutes and good hemostasis was noted.
Any thoughts?
Thank you
Thought the postpartum period was 6 weeks. So wouldn't this still be considered in the postpartum period. Patient had heavy vaginal bleeding & cramping and passing baseball size clots.
Here is the procedure: 2 Sims retractors were paced in the anterior & posterior aspects of the vagina. The anterior lip of the cervix was visualized and grasped with a single-tooth tenaculum. A #10 Hegar dilator was utilized and noted to moved freely through the cervix. A #10 rigid suction surette was then introduced into the uterus and suction was initiated. Suction was continued rotating with outward traction and a large amount of procedures of conception consistent with placental tissue were evacuated from the uterus. Two passes were undertaken. The uterus was noted to be clear on ultrasound. A sharp curette was introduced and a gritty feeling was noted throughout the uterus. Howe, every time a curette was introduced into the uterus, more bleeding was noted concerning for abnormal placentation of some sort. IM Methergine was given. Uterine tone was noted to be good. The cervix was visualized for multiple minutes and good hemostasis was noted.
Any thoughts?
Thank you