Ob-Gyn Coding Alert

The August 2006 Reader Question -Coding Changes When You Own Equipment- recommended that if your ob-gyn performs a diagnostic hysteroscopy in the office and the patient has a dilation and curettage in the OR, you can bill both services using:

- 58555 (Hysteroscopy, diagnostic [separate procedure]) for the diagnostic hysteroscopy.
 
- For the D&C performed later in the hospital, you should use either 58120 (Dilation and curettage, diagnostic and/or therapeutic [nonobstetrical]) or 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C), depending on whether the ob-gyn uses the hysteroscope again.

Keep in mind: In the original question, the patient went to the OR for the D&C on the same date as the office hysterectomy. In that case, the modifier on the D&C will be 58 (Staged or related procedure or service by the same physician during the postoperative period), not 78 (Return to the operating room for a related procedure during the postoperative period), because the D&C is a more extensive procedure than the diagnostic hysteroscopy, and of course the physician is not returning the patient to the operating room because the he performed the first procedure in the office setting.

You may think that when a code has no global days you do not need a modifier. But a procedure with zero global days has a global period that includes the day of the procedure. Therefore, if your ob-gyn performs another procedure on the same day as the original, you should use a modifier to prevent bundling of the two procedures or a fee reduction on the second procedure.

If your ob-gyn schedules the D&C for the next day or next week, you do not need a modifier.