Ob-Gyn Coding Alert

Question: We have been using the sterilization diagnosis for patients who come back for an HSG (hysterosalpingogram) after having the Essure procedure. The hospital is requesting us to use a diagnosis of symptoms, but the patient is not having symptoms. We are only checking to be sure the Essure is in place and the tubes are blocked. What diagnosis code should I use?

Washington Subscriber
 
Answer: The correct diagnosis is V26.51 (Tubal ligation status). This is a generic term that applies to any method for the sterilization procedure, including fulguration, ligation, placing a band or clip, or inserting a device. 

Payers will either cover this procedure or they won-t, and the patient will be responsible for the charge. Most payers will cover the HSG if they covered the Essure procedure.

HSG is 58340 (Catheterization and introduction of saline or contrast material for saline infusion sonohysterography [SIS] or hysterosalpingography) plus 74740-26 (Hysterosalpingography, radiological supervision and interpretation; professional component) if the ob-gyn does not own the equipment. This is an x-ray procedure, not ultrasound, so your ob-gyn probably does not own the equipment.