Ob-Gyn Coding Alert

Getting Paid When Technology Is Ahead of Coding:

Thermal Balloon Ablation

Until recently, most ob/gyns treated dysfunctional uterine bleeding (DUB) with hysteroscopic endometrial ablation. But in December 1997, the Food and Drug Administration (FDA) approved the use of a thermal device designed to ablate the endometrium using a balloon that is inserted into the uterus with a catheter. The balloon is filled with heated water, which has the same effect on the tissue as surgical ablation. This alternative therapy is known as uterine balloon therapy (UBT).

The problem for ob/gyn coders is that the CPT has not yet caught up with the latest technology, and there is currently no CPT code that precisely defines UBT. The American College of Obstetricians and Gynecologists (ACOG) has requested a code for this service, but that request may not be approved for quite some time. What should coders do in the meantime? Can you use 56356 for hysteroscopy and endometrial ablation, as you would for a surgical endometrial ablation? How does thermal ablation differ? Do these differences require a modifier? Can you code for the thermal balloon itself? The answers to these and other questions are quite logical once you fully understand dysfunctional uterine bleeding and uterine balloon therapy as a treatment for certain patients.

What is Dysfunctional Uterine Bleeding?

Dysfunctional uterine bleeding, also known as menorrhagia, is the formal name for prolonged or excessive menstrual bleeding. Current ICD-9 codes associated with this condition are 626.2 (excessive or frequent menstruation), 626.4 (irregular menstrual cycle), 626.6 (menorrhagia), 626.8 (other) and 626.9 (unspecified).

There are many possible causes of this condition, including a hormonal imbalance, abnormal ovulation, uterine trauma, polyps, fibroid tumors, cancer, cervicitis and other infectious conditions. It also can be caused by irritation from an intrauterine device, or it may be a sign of an ectopic pregnancy.

Thermal ablation is not the recommended therapy for all types of DUB. It is not an appropriate therapy when the etiology includes cervicitis, vaginitis, endometriosis, salpingitis, cystitis, fibroids, myomas, unresolved hyperplasia, endometrial carcinoma and other adnexal pathologies. Thermal ablation is contraindicated for patients who have a weakness of the myometrium, an abnormally shaped uterine cavity, an IUD in place, an active genital-urinary infection, sensitivity to latex or a desire to become pregnant.

What is Uterine Balloon Therapy?

Uterine balloon therapy is a technique for ablating the endometrium in patients who have menorrhagia attributed to benign causes and who do not wish to become pregnant. Like surgical ablation using an electrode loop, rollerball or laser, UBT destroys the endometrial uterine lining so that it can no longer grow and shed through menstruation. With the elimination of the endometrium, most patients will become infertile, although UBT is not considered a form of birth control.

The only FDA approved uterine balloon therapy on the market at this [...]
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