Wiki Postpartum D&C

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suec

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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
 
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If you had to dilate, then you'd report the 58120; the cervix was closed. 59160 is usually done at the same episode as the delivery or very shortly after. It really doesn't have anything to do with the postpartum timing per se, it's whether or not the cervix needs to be dilated. CPT Lay descriptions are helpful in this case, as follows:

58120 The physician inserts a speculum into the vagina to view the cervix. A tool is used to grasp the cervix and pull it down. A dilator is inserted into the endocervix and through the cervical canal to enlarge the opening. The physician places a curette in the endocervical canal and passes it into the uterus. The endometrial lining of the uterus is scraped on all sides for diagnostic or therapeutic purposes.

59160 The physician scrapes the endometrial lining of the uterus following childbirth. The physician passes a curette through the cervix and endocervical canal, and into the uterus. Due to the large, soft postpartum uterus that is especially susceptible to perforation, a large blunt curette, also known as a "banjo" curette, is preferable to the suction curette. The physician gently scrapes the endometrial lining of the uterus to control bleeding, treat obstetric lacerations, or remove any remaining placental tissue.
 
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Pam Warren said:
If you had to dilate, then you'd report the 58120; the cervix was closed. 59160 is usually done at the same episode as the delivery or very shortly after. It really doesn't have anything to do with the postpartum timing per se, it's whether or not the cervix needs to be dilated. CPT Lay descriptions are helpful in this case, as follows:

58120 The physician inserts a speculum into the vagina to view the cervix. A tool is used to grasp the cervix and pull it down. A dilator is inserted into the endocervix and through the cervical canal to enlarge the opening. The physician places a curette in the endocervical canal and passes it into the uterus. The endometrial lining of the uterus is scraped on all sides for diagnostic or therapeutic purposes.

59160 The physician scrapes the endometrial lining of the uterus following childbirth. The physician passes a curette through the cervix and endocervical canal, and into the uterus. Due to the large, soft postpartum uterus that is especially susceptible to perforation, a large blunt curette, also known as a "banjo" curette, is preferable to the suction curette. The physician gently scrapes the endometrial lining of the uterus to control bleeding, treat obstetric lacerations, or remove any remaining placental tissue.
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Hi, I'm just wondering if you can use an ob/pp icd-10 code with 58120 or if a gyn code has to be assigned in this case? Thanks
 
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