20160430 - Save up to 35% on Everything You Need to Get Certified | Learn More

Results 1 to 10 of 10

Thread: Diagnostic hysteroscopy w/D&C and Novasure Ablation

  1. #1
    Join Date
    Apr 2007
    Location
    Seacoast- Dover New Hampshire
    Posts
    604

    Default Diagnostic hysteroscopy w/D&C and Novasure Ablation

    I am having some confusion as to the coding for this. The codes I am reading are confusing. I have not had any formal OBGYN training. I read the op notes and figure out the code with the coding companion. But on this monday morning I can't think. How would I be able to capture all the components without unbundling the codes. MD states diag hysteroscopy D&C and novasure ablation. Thank you for youe help.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  2. #2
    Join Date
    Apr 2007
    Location
    Albany, New York
    Posts
    456

    Smile

    Unfortuntately, the only procedure you can code here is the ablation.

    I equate this scenario to taking a biopsy of a lesion (D&C), and then destruction of what is left of that same lesion (ablation) during the same operative session.

    Hope this helps.......
    Karen Maloney, CPC
    Data Quality Specialist

  3. #3
    Join Date
    Apr 2007
    Location
    Kansas City, MO
    Posts
    736

    Default

    First, if you are new to OB/Gyn coding I would highly recommend getting the OB/GYN CODING MANUAL: Components of Correct Procedural Coding from ACOG. You can order it from their website www.acog.org .

    Now, to answer your question, based on the information you provided you can bill out the 58563. A diagnostic hysteroscopy is included in this procedure. Now the D&C per CCI is bundled with a "1", so it can be unbundled if it is truly a separate procedure. The OP note will have to support that. I will add that most commercial carriers have additional internal edits and the D&C is included, no modifier allowed.
    Angela Jordan, CPC
    AAPC of Kansas City, Region 5 - Southwest
    Medical Revenue $olutions
    Managing Consultant

    angela@medicalrevenuesolutions.com

  4. #4
    Join Date
    Apr 2007
    Location
    Albany, New York
    Posts
    456

    Smile

    The correct CPT for the Novasure Ablation is 58353 (this is not a "hysteroscopic" procedure).

    My CCI edits indicate that 58558 (Hystero w/ D&C) cannot be billed with 58353 (even if an appropriate modifier is present).
    Karen Maloney, CPC
    Data Quality Specialist

  5. #5
    Join Date
    Apr 2007
    Location
    Seacoast- Dover New Hampshire
    Posts
    604

    Default

    I do have the 2009 Coding companion. Is this different from the coding manual? I had the 58563 as the code and was told that the D&C was also done. I was looking to see if it could be coded separately. I have gotten confused with the closeness of the procedures.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  6. #6
    Join Date
    Apr 2007
    Location
    Kansas City, MO
    Posts
    736

    Default

    I would review the OP note and see why the D&C was done. If it was done to necessitate the Novasure, don't bill it.

    Here is an excerpt from one of the OB/Gyn workshops I went to with Melanie Witt. She used to work for ACOG and is now one of the National authorities on OB/Gyn coding.

    No matter how the CPT words the procedures there are only two codes for an endometrial ablation.? 58563 when a hysteroscope is used at any time during the procedure and 58353 when a hysteroscope is not used.? NovaSure with no scope is 58353; NovaSure with a scope is 58563.

    Melanie Witt, RN, CPC-OGS, MA


    As for the manual, it is a little different and it contains ACOG official comments on several issues that can be used when appealing claims to commercial carriers.
    Angela Jordan, CPC
    AAPC of Kansas City, Region 5 - Southwest
    Medical Revenue $olutions
    Managing Consultant

    angela@medicalrevenuesolutions.com

  7. #7
    Join Date
    Apr 2007
    Location
    San Gabriel Valley
    Posts
    30

    Default Novasure

    use 58563 with Hysteroscopy and
    58353 W/O Hysteroscopy.

    When you read the op notes and it states Novasure you use one of these codes

  8. #8
    Join Date
    Apr 2007
    Location
    Seacoast- Dover New Hampshire
    Posts
    604

    Default Ablation

    Now, pt has the ablation and it did not work. I would think that even though the ablation did not work I could still code for the ablation w/D&C.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  9. #9
    Join Date
    Apr 2007
    Location
    Greeley, Colorado
    Posts
    2,046

    Default

    Quote Originally Posted by magnolia1 View Post
    The correct CPT for the Novasure Ablation is 58353 (this is not a "hysteroscopic" procedure).

    My CCI edits indicate that 58558 (Hystero w/ D&C) cannot be billed with 58353 (even if an appropriate modifier is present).
    If the surgeon uses the hysteroscopic prior to the Novasure ablation and then again following to view the ablated endometrium, wouldn't you code 58563?
    Lisa Bledsoe, CPC, CPMA

  10. #10

    Default

    58353 is the ablation without hysteroscopic guidence
    58563 is with hysteroscopic guidence

    If the physician did a hysteroscopy/D&C(58555) and then an ablation without hysteroscopic guidence(58353) you will want to bill the procedure with highest value, in the case the 58353 has a higher RVU. 58555 is bundled with 58353.

    Jamie

Similar Threads

  1. Replies: 1
    Last Post: 05-09-2014, 12:11 PM
  2. Replies: 0
    Last Post: 09-13-2012, 09:37 AM
  3. Replies: 2
    Last Post: 08-17-2012, 06:50 AM
  4. Replies: 2
    Last Post: 11-22-2011, 02:00 PM
  5. Replies: 2
    Last Post: 03-03-2009, 10:56 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.