Ob-Gyn Coding Alert

Some practices are beginning to offer the Essure implantation to their patients as a form of tubal ligation, but the question, as always with new procedures, is: "How should I code for this?"
 
The Essure micro-insert is a new tubal ligation device approved by the U.S. Food and Drug Administration that involves using a hysteroscope to place the insert into the proximal portion of each fallopian tube. When the device is released, it expands and anchors in the fallopian tube where it will cause tissue to form around the device that in a few months will block the tube, resulting in sterilization. The ob-gyn can perform the procedure in the office under local anesthesia or conscious sedation, and it takes approximately 35 minutes. The patient must stay on birth control until the doctor can perform a hysterosalpingogram (74740, Hysterosalpingography, radiological supervision and interpretation; and 58340*, Catheterization and introduction of saline or contrast material for hysterosonography or hysterosalpingography) after three months to verify that the tubes are blocked.
 
In the April Ob-Gyn Coding Alert, a Reader Question offered three coding possibilities for inserting this new device. Since then, several readers have commented that two of the coding solutions, which involved reporting the hysteroscopy separately, were not accurate. Consequently, we have decided to revisit the subject and discuss in more detail the pros and cons of each coding solution. Examine the Procedure On its face, the new procedure seems to be an occlusion of the fallopian tubes by a device through the vaginal canal. That would imply that you should use 58615 (Occlusion of fallopian tube[s] by device [e.g., band, clip, Falope ring] vaginal or suprapubic approach). But before deciding to report this code, you should know that CPT guidelines state that the code selected should accurately identify the service performed, not merely approximate the service provided.
 
So the first question to ask will be, "Is code 58615 substantially correct?" CPT created 58615 to report a vaginal or suprapubic surgical approach to occluding the fallopian tubes: that is, a colpotomy incision into the vaginal wall or making a small incision above the pubic bone. The Essure procedure, on the other hand, uses a hysteroscope to view the tubes to ensure that the ob-gyn can perform the procedure and then guide the insert's placement. The physician doesn't make a surgical incision.
 
From a pure theoretical standpoint, therefore, CPT does not provide a code for the Essure procedure, and the unlisted hysteroscopy code (58579, Unlisted hysteroscopy procedure, uterus) seems to be the only correct coding solution.
 
"In a perfect world where all payers accept unlisted-procedure codes, this might be true," says Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va. "Many [...]