Ob-Gyn Coding Alert

Question: My ob-gyn performed a new procedure called the Microsulis microwave endometrial ablation system. What is this and how should I code for it?

Nebraska Subscriber

Answer: Ob-gyns often use endometrial ablation to treat dysfunctional uterine bleeding, or menorrhagia. Current ICD-9 codes associated with this condition include 626.2 (Excessive or frequent menstruation), 626.4 (Irregular menstrual cycle), 626.6 (Metrorrhagia), 626.8 (Other) and 626.9 (Unspecified). A number of conditions can cause this, such as hormonal imbalance, abnormal ovulation, uterine trauma, polyps and cancers, among others.

During microwave endometrial ablation, the physician first employs a hysteroscope to determine whether any perforation, possible false passage or uterine wall damage is present. Then, he inserts a thin, wand-like device into the uterus via the cervix to deliver low doses of microwave energy that cause rapid and controlled heating of the uterine lining, permanently removing the tissue that produces the excessive bleeding.

When coding this procedure, you should report 58563 (Hysteroscopy, surgical; with endometrial ablation [e.g., endometrial resection, electrosurgical ablation, thermoablation]). The surgeon may use a paracervical block during the ablation. If this is the case, you can also report  64435 (Injection, anesthetic agent; paracervical [uterine] nerve), but remember to add modifier -47 (Anesthesia by surgeon) to 58563. For the wand, you should submit the supply code A4649 (Surgical supply; miscellaneous).