# diagnostic hysteroscopy



## slrollings (Aug 16, 2009)

Pt had a diagnostic hysteroscopy and then a D&C and Novasure ablation. I coded as a 58563. Supervisor points out that I can't use this code because the hysteroscope was removed and then the D&C and ablation took place. (she's right)  She tells me to only bill the 58535. Yes, that would be the correct code, but when I ask about the diagnostic hysteroscopy, she tells me it's a "separate procedure" and therefore cannot be billed. 

Isn't that exactly what a separate procedure is? I think we should be able to bill the 58555 in addition, because it was a separate procedure. Her assistant agrees with her, so I need some type of backup. 

This seems like such a basic coding issue, I can't believe we're even having this discussion. Am I losing it?

Thank you for your help!


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## bbollinger (Aug 17, 2009)

*Bundling issue*

Your problem is going to be the bundling issue.  58563, endometrial ablation, is performed with a hysteroscope, therefore bundling a diagnostic hysteroscopy into the ablation, as well as the D&C.


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## slrollings (Aug 18, 2009)

You are correct about the 58563, but it wasn't performed in that manner. Sorry, I wasn't very clear.

My question is about the 58535 with a diagnostic hysteroscopy. The physician literally put in the hysteroscope, did the diagnosic exam, took it out, and then went back in and did the D&C and Novasure ablation without the scope. 

Wouldn't you bill for the diagnostic hysteroscopy in addition to the ablation, since they are two separate procedures?

Thanks for your help!


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## bbollinger (Aug 18, 2009)

When you look at the definition of 58563, which is how you would bill the ablation, it states "the physician advances the hysteroscope through the vagina and into the cervical os to gain entry into the uterine cavity.  The physician inspects the uterine cavity with the fiberoptic scope and ablates the endometrium by various methods, such as resection, electrosurgical ablation, or thermoablation".  When the physician "inspects" the uterine cavity, I believe that equates the diagnostic portion of the hysteroscopy, thereby bundling the diagnositic hysteroscopy to the ablation.  They really aren't two separate procedures since they're performed at the same time with the same instrumentation on the same body part.

I cannot locate a CPT code '58535' - which procedure are you referring to, specifically, with this code?


I hope I can help you!!  And I hope this makes sense!


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## slrollings (Aug 18, 2009)

Sorry, my dyslexia gets the best of me sometimes - the code I meant is 58353 - endometrial ablation, thermal, without hysteroscopic guidance.

She's telling me that since the scope was removed before the ablation, to use the 58353. I'm thinking that technically she's right, but they also did the diagnostic hysteroscopy, so they should be able to bill for that also. She says no to the diagnostic because it's a separate procedure - but I think it should be yes because it's a separate procedure.

Clear as mud, right? (again sorry about the dyslexia thing)


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