# polyp or fibroid



## efuhrmann (Jul 26, 2010)

Can someone explain the difference between a polyp and a fibroid.  I am being asked this question:  if, during the course of a uterine polyp removal the saline normally used gets replaced with another fluid and dilation is performed in order to retrieve a very large polyp is the 58558 the correct CPT?  The procedure is done hysteroscopically and the doctor says it's as much work as a hysteroscopic myomectomy(58140)?? That is how the doctor explained it to me and I wasn't sure what fluid she was referring to but I am hoping someone out there can fill me in on the details of the code 58140.


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## imjsanderson (Jul 29, 2010)

First of all 58140 is an abdominal approach so if it was done hysteroscopically you would definately not use this code.  Have you reviewed the path report?  It may be that it is a polyp that was just more difficult that usual.  If the doctor's report has good documentation you may be able to add -22.


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## preserene (Jul 29, 2010)

Uterine Fibroid Vs Polyp:
Yes IMJSanderson is very much correct. IT IS NOT 58140 which is an abdominal open route and needs opening of the uterus to reach the cavity;  it is “a myomectomy procedure”.For uterine endometrial polyp the physician, do not take up that route at all (unnecessary and very much invasive). Moreover ,the myomectomy is a very much distinct and technically different procedure from polypectomy,which just needs a simple excision or twist removal.
[The modern instruments and scopy procedures have made the removal of both easier though]
The point is the route taken for procedure here, is simple conventional vaginal-cervical one.
You can not report  with the code 58558, because it was not hysteroscpoic /nor a hysteroscopic ablation.
The procedure was like the endometrial sampling biopsy. There isn't a code for endomentrial sampling biopsy with dilation. There isn't a code for endometrial polyp/fibroid removal/excision vaginally with/without dilation  (without hysteroscopic procedure).
*So it stands at the level of removal of tissues of the endometrium  with dilation and curettage diagnostic and therapeutics-  58120 (non obstetrical) with modifier 22 appended to it.*You append diagnostic code for endometrial polyp attached to it and a written report for the increased procedure
Let me explain the differences between them-Macroscopically, Microscopically(Histopathologically), and anatomically.
Anatomically a ‘Polyp'  is pedunculated (pedicled) growth, arising  anywhere from mucous membrane, like vagina, cervix  or uterus. It can be benign or malignant any shape. Fibroids are benign growth or tumor arisng from uterus and its tissues,usually smooth surface and contoured; dependng on the area it occupies, it is named as submucous, interstitial, intramural, subserous, cervical, or broad ligament fibroid. The submucous one is the one you are placing under discussion now. 
It can Macroscopically/Hysteroscopically look like submucous fibroid (usually the fibroid can reach a very big size and as such cannot depend much on the size, especially  when  pedenculated (having the very  small capacity/volume of the uterus in mind) and  the pathology report is the final.
Here the size of the mass was big that actually it wouldn't have been able to remove it  with the twist or excision as we  do with the polyps usually. More so, it would have been a very submucus fibroid (with a pedicle) hanging in the uterine Cavity, with the contour and surface nature of Fibroid.
 Histopathologically the pathology report can tell you whether it is benign or malignant and the cytology.

Well, would any expert come for the correct reporting of this procedure please,
irrespective of the path report. The path report can not change the assigning procedural code, however, it was not a myomectomy, even if the report comes as Fibroma


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