The toradol should be oncluded in the procedure, however, AGOC does say you can bill a paracervical block if performed:
Correct Reporting of Paracervical Block with Hysteroscopy Procedures
Written by Donna Tyler, CPC, COBGC, ACOG Coding Specialist
There is a difference between commercial and Medicare payers when reporting a paracervical block (CPT-4 code 64435) separately from the hysteroscopy procedures. The 2009 ACOG Coding Manual differentiates this reporting.
For non-Medicare patients, according to the ACOG Coding Manual the following hysteroscopy codes were valued to include the paracervical block:
58563 (Hysteroscopy, surgical; with endometrial ablation (eg, endometrial
resection,electrosurgical ablation, thermoablation))
58565 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion
by placement of permanent implants)
For these two codes only, the paracervical block should not be reported separately.
However, the Coding Manual states that paracervical block code 64435 may be reported separately when performed with the following hysteroscopy codes:
58555 (Hysteroscopy, diagnostic (separate procedure))
58558 (Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy,
with or without D & C)
58559 (Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method))
58560 (Hysteroscopy, surgical; with division or resection of intrauterine septum (any
58561 (Hysteroscopy, surgical; with removal of leiomyomata)
58562 (Hysteroscopy, surgical; with removal of impacted foreign body)
The 2009 ACOG Coding Manual also specifies, that for Medicare patients based on the Correct Coding Initiative (CCI), when reporting hysteroscopy procedures the paracervical block is bundled into codes 58555, 58558, 58559, 58560, 58561, 58562 and 58563. However, Medicare will provide separate reimbursement from the aforementioned hysteroscopy codes when the paracervical block (code 64435) is appropriately performed and submitted with a modifier. To differentiate between the hysteroscopy procedure and paracervical block, modifier 59 (distinct procedural services) should be used (eg, 58558, 64435-59).
In addition, the Coding Manual indicates that for Medicare patients, CPT-4 code 64435 is not bundled into hysteroscopy code 58565. This is the only hysteroscopy code that Medicare does not bundle the paracervical block into. As such no special modifier is required in order to receive separate reimbursement.
If you havenâ€™t purchased a copy of the 2009 OB/GYN Coding Manual: Components of Correct Procedural Coding , hereâ€™s why you should! The Coding Manual has been extensively revised for 2009, and now includes the bundling information for each code both from Medicareâ€™s National Correct Coding Initiative (CCI) and for non-Medicare patients, ACOGâ€™s clinical vignettes. This change allows coders to compare the bundling issues between Medicare and non-Medicare patients. The ACOG Coding Committee Opinions that relate to coding and reimbursement issues are included, and all codes are grouped by body system or type of service to complement the AMA CPT book designations. Updated annually by ACOG, this manual contains 2009 CPT codes and descriptions for procedures performed most often by ob-gyns.
To place your order contact the ACOG distribution center at 1-800-762-2264 or place your credit card order online at:
Questions and/or comments may be sent to ACOG's Coding Staff via email at Coding@acog.org
ACOG Coding Workshops & Webcasts
Savonne Montue, MBA, RHIT, ACS-OB, COBGC
Manager, Coding Education
Donna Tyler, CPC, COBGC
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