# Coding for multiple procedures



## jjcastel (Jun 24, 2011)

Help!!!

Pt was admitted to the hospital for incomplete abortion with significant vaginal bleeding. procedures performed were induced AB by D&E, Exp Lap, total Hysterectomy, Cystoscopy, removal of fibroids and curettage post partum.  Not sure which to bill or all bundled.


can anyone help me?


THANK  YOU


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## stheck (Jun 24, 2011)

I don't have an OB book, but it seems to me that the exploratory lap, fibroid removal, cystoscopy would be bundled, or at least not billable with a TAH. I would say do the 58150 and the 59841 with a 51. And you may be able to bill the curettage?

Sorry I couldn't be more help.


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## tmerickson (Jun 28, 2011)

You would only bill the hyst.


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## preserene (Jun 28, 2011)

TME, Somehow I feel it is not fair to just code Hysterectomy and get away with that.
The hysterctomy was not the intended procedure at the out set.
It invloved very extensive journey of D&E, then myomectomy which itself is an extensive, cumbersome and time consuming major procedure and please note it was undertakenas an emergency procedure to contro bleeding, and when the bleeding not controlled with this also,  hysterctomy was carried out as a life saving measure.  
I feel that this myomectomy need to be reported by all means separately with modifier -59;
 If not allowed, atleast needs to be addressed with mod-22 with a detailed report of the myomectomy procedure.
Well the D&E, explor.laparotomy, Curettage all would be bundled in to the major procedure.
Thirdly, cystoscopy is  not a component or integral part of hysterectomy.
it is underatken  as a final separate  and distinct procedure to verify the other organ is not injured. It also needs to be reported separately.

To sum up,I feel ( my school of thought) that  *it needs three code assignments:*   hysterectomy code , myomectomy code with -59 and -22, and diagnostic cystoscopy code.
 It may not be acceptable but I feel it is justified when it is presented with pertinent and detailed report from the Physician.
Thank you


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## stheck (Jun 25, 2012)

I was just reviewing my past posts, and saw this one. I checked my OBGYN coding companion, and only the hysterectomy and the Induced D/E is billable and not bundled with each other. Everything else is bundled with the Hyst. Also, there is not enough information about the hyst; is it lap assisted or open?


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