# Hyster w/ D&C, Attempted endo ablation



## Jamie Dezenzo (Apr 23, 2009)

HELLO ALL,

Hysterscope D&C done

NovaSure was placed into the uterine cavity and was unable to get the array to open completely. This was unsuccessful and device was removed.

Then Thermachoice balloon was obtained and the was attempted muliple times as well which malfunctioned. Felt that these difficulties were related to the samll architectore fo her uterus.

Would this still be billed 58563-74 bundling 58558 or just 58558? Attempted vs discontinued gets me EVERYTIME!

THANKS!


----------



## Anna Weaver (Apr 23, 2009)

*attempted*

They do me too, I had one just like this the other day. I just coded 58558. The other was attempted, but nothing was done on it so I coded what was completed. Like you, I'm not sure, but that's what I did. Hopefully we'll get some feed back here!!


----------



## trose45116 (Apr 23, 2009)

can you post the op report


----------



## Jamie Dezenzo (Apr 23, 2009)

*OP note*

The cervix was then dilated up a 7-mm size. The hysteroscope was assembled and advanced into the uterine cavity. The uterine cavity was noted to be normal in shape with no anatomic defects. The tubal ostia were visualized. The uterine measurements and cervical measurements were obtained. Sounding lenght was 8cm. Cervical length was 4cm. The sharp curettage was then performed, revealing a minimal amount of tissue.

The Novasure device was then obtained. It was placed into the uterine cavity. With opening, I was unable to get the array to open completely. Multiple attempts were placed with reinsertion and attempts to get the array to completely open. This was unsuccessful. I felt this was due to the very narrow anatomy of the fundus. At this point, the NovaSure device was removed.

The Themachoice balloon equipment was obtained. The Thermachoice balloon was then primed and set up. The fluid was evacuated, and the pressure was brought to a minus 180. The Thermachoice was then placed into the uterine cavity. Pressure was brought up to a stable pressure of approx 165. After observation, this pressure was felt to be stable. The Thermachoice was then activated. Within seconds of heating, the pressure rose above 200, and machine turned off with and error report. At this point, the company rep was called. I had a discussion with him about what had happened. We removed the fluid and removed the Thermachoice from uterus. Then reprimed balloon, re-established pressure at minus 180, inserted the Thermachoice balloon. Upon achieving a stable pressure of approx 165 to 170, the device was then reactivated. As the pressure rose, I evacuated a little fluid to keep the pressure in the adequate range. After approx 10 to 15 seconds, I had the same error report. After this, Thermachoice was removed as well.


----------



## Jamie Dezenzo (Apr 28, 2009)

*2nd request*

Any takers??


----------

