Ob-Gyn Coding Alert

Question: Our ob-gyn performed a diagnostic laparoscopy and dilation and curettage (D&C). He documented that he did the D&C because of dysfunctional uterine bleeding, but he performed the diagnostic laparoscopy because of the patient's pelvic pain. Can we code the two procedures separately, or are they bundled? Louisiana Subscriber Answer: You can report the diagnostic laparoscopy (49320, Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) and the D&C (58120, Dilation and curettage, diagnostic and/or therapeutic [nonobstetrical]) separately. You should append modifier -59 (Distinct procedural service) to 49320 to show that it is separate and add modifier -51 (Multiple procedures) to 58120. Be sure to link the dysfunctional uterine bleeding diagnosis (626.8) to 58120. You should also link the diagnosis for pelvic pain (625.9) to 49320. If the pathology report comes back with any findings from the laparoscopy or the D&C, you should report those diagnoses in addition to the preoperative signs and symptoms. Some payers resist reimbursing for this code combination. Consequently, you may want to include an explanation of the claim, including information about the patient's history of the condition and any other treatments that the ob-gyn attempted but failed.