Ob-Gyn Coding Alert

Question: The physician stated that he performed a cervical dilation, intrauterine device (IUD) extraction, and endometrial curettage. His documentation further states that he used the hysteroscope. Would correct coding be 58558 and 58562-51 or just 58562?

Louisiana Subscriber

Answer: Your first instinct is correct. You should report these procedures as 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C) for the endometrial curettage and 58562 (... with removal of impacted foreign body) for removing the IUD. The National Correct Coding Initiative does not bundle these procedures, so billing them separately is safe.
 
Based on the 2004 Medicare Physician Fee Schedule, 58558 has 7.40 relative value units, not adjusted for your geographic location, while 58562 has 8.03. Therefore, you should list 58562 first and 58558 second. You don't have to add modifier -51 (Multiple procedures) because the codes are from the same code family.
 
On the other hand, you will have to apply the multiple-endoscopy rule, which states that because each procedure has a diagnostic hysteroscopy built in, you should get paid for it only once. According to the American College of Obstetricians and Gynecologists, you should bill your full fee for both 58562 and 58558, and the insurance carrier will automatically calculate the value of the base code (diagnostic hysteroscopy) to subtract from its payment for the second procedure.
 
Don't be surprised if the payer tries to deny 58558. Be sure to use an appropriate diagnosis code to support the medical necessity that is different from the impacted IUD code.