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endo ablation 2 attempts both aborted - Need some help

  1. Default endo ablation 2 attempts both aborted - Need some help
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    Need some help on this one. In office; endometrial ablation with hysteroscopy/biopsy, conscious sedation; 1st attempt with Novasure. The hyst and biopsy completed uterine sounding completed; cavity integrity passed but sheath could not fully deploy and Novasure was aborted. Immediate 2nd attempt with Thermachoice; balloon inserted without difficulty but unable to inflate with the minimum volume required and procedure was aborted. Any suggestions on how to code this to get doc reimbursed for completion of hysterscopy/biopsy and both disposable supplies? (Novasure and Thermachoice)
    Thanks for any help.

  2. Default
    There are only 2codes available for ablation.
    Your Hysteroscopy code goes with 58563.
    Bill for completed procedure 58558 and 58563 with modifier 52 attached to it; (sequence them in the order of highest payment). Also V code to show that the procedure was aborted; and a report -documentaion- showing a 'dictate' in their operative notes how much of the service or procedure they had planned to render was actually completed, and do so in terms of a percentage. The idea is to give the payer a guide to what might be appropriate reimbursement, especially when a service is reduced.
    Provide a detailed, accurate, easily understandable documentation

    Billing the higher level procedure is better. In your case the 58563 is the one aborted procedure

    Aborted or discontinued ASC surgical procedures," instructs hospitals to report the appropriate ICD-9-CM diagnosis code (V64.1, V64.2, or V64.3) on the bill. If the procedure was discontinued before or after anesthesia was induced, report the procedure using the appropriate CPT/HCPCS code with a modifier. Modifiers 73 an d74 not for Physician's office.

    But contact insurers to verify correct coding procedures prior to submitting claims.

    Will have to prepare manual bills if the billing system will not "allow" the reporting of a V64 diagnosis and CPT code.

    I feel we need another expert openion for this who have great experience in billing.
    You are most welcome to throw more light upon this

  3. #3
    58558 will bundle with the 58563. Modifier is not allowed per CCI edits. I would code the 58563 alone. 58563 is worth way more RVUs when done in an office setting. The increase in RVUs is to cover the physicians supply cost. You can try billing one or both supplies in addition to the 58563, but you may not get paid for them. Like I say, the 58563 is worth a lot of RVUs when done in an office setting.

    I used to have a newsletter tidbit (OBGYN Coding Alert, I believe) telling me that when a procedure is attempted but not completed, you still get to bill for the procedure, which is why I would bill out the 58563. I know the biopsy procedure was completed, but the 58558 is going to bundle with a 58563, and the 58558 alone isn't indicative of the amount of work actually done in this case. With the amount of work described, I would look for someone else's opinion on whether a 52 modifier is needed at all.

    Maybe someone else has that OBGYN Coding Alert article, or another of equal value?

    Becky, CPC

  4. Default
    58558 will bundle with the 58563
    I know it would be bundled when the perfect/complete 58563 is performed and billed.
    but she wants the 58558 not to be skipped from payment as such.
    But 58558 is not a separate procedure either. I wished this could be listed / sequenced as a last one after clarification with the payers.
    we say it is included because it is the same hysteroscopic surgical procedure at th esame session by same surgeon.

    You cannot be paid fully for the 58563 an aborted procedure. That is why i said it has to go with -52 any way, in which case the completed one 58558 and the supplies of Nova sure stuff also shd not go unpaid. that is why i said the report and asking the payer before billing would clarify better.
    I am also curious about the outcome of this thread!

  5. #5
    OK, I got an answer on this one from another coding source. 58563-52 is the proper way to code for this per Melanie Witt, CPC, RN, COBGC, MA

    Becky, CPC

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