# Looking for Assistant with Multiple Procedures



## paynemedbill (Jan 12, 2012)

Our provider performed the following multiple procedures on patient:

D&C hysteroscopy, hysterscopic submucous myomectomy and cervical myomectomy, diagnostic laparoscopy, mini laparotomy and abdominal myomectomy.

Any suggestions would be greatly appreciated.  "Thank You" in advance for any and all responses.


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## ajs (Jan 12, 2012)

paynemedbill said:


> Our provider performed the following multiple procedures on patient:
> 
> D&C hysteroscopy, hysterscopic submucous myomectomy and cervical myomectomy, diagnostic laparoscopy, mini laparotomy and abdominal myomectomy.
> 
> Any suggestions would be greatly appreciated.  "Thank You" in advance for any and all responses.



One of the best ways to get down to which codes to use in a case of multiple procedures, is to write down all the codes for the procedures done, and then start looking at what is bundled and what order things need to be listed in.

Start with the Hysteroscopy codes:  
  58558 Hysteroscopy D&C, 58561 Hysterscopy w/myomectomy - when you check CCI edits these codes are clear and can both be billed.

Next the Laparascopy, Laparotomy and Abdominal myomectomy:
  49320 Dx Laparascopy, (no code for mini laparotomy), 58140 or 58146 Abdominal myomectomy (depending on number or size) - check the CCI edits and find you can bill these together but you will need a modifier 59 on the 49320 and also the dx code that shows the procedure was coverted from laparoscopy to open.

Check the CCI edits for all the codes:
  58558, 58561, 49320, and 58140 and you will see that you will also have to add a modifier to 58561 to show that myomectomies were done both hysteroscopically and abdominally.

Then you put them in order of RVU on your claim so it would look like this:

58140
58561-59-51
58558-51
49320-59-51

make sure you attach to appropriate dx codes to the procedures.  Remember that you still may not get reimbursed on all the codes, some payers may have different bundling edits.


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## paynemedbill (Jan 17, 2012)

Thank you.


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