Ob-Gyn Coding Alert

Question: We billed a 59820 – DX 632. The patient was still bleeding, so we brought her back 2 weeks later and performed a 58558 with DX-632. Can we bill a 58558 when my doctor did the hysteroscopy for retained products of conception?

Texas Subscriber

Answer: No, because at this point, she is still in the “incomplete” abortion stage. You should be billing 59812 (Treatment of incomplete abortion, any trimester, completed surgically) and no longer bill 632 (Missed abortion), since there is no longer a fetus present.

You can possibly bill the hysteroscopic approach as 58555 (Hysteroscopy, diagnostic [separate procedure]) if there was a medical indication for doing the procedure via the hysteroscope, or you could also consider adding a modifier 22 (Increased procedural service) to 59812 to account for the additional work involved in using the hysteroscope.

The American Congress of Obstetricians and Gynecologists (ACOG) has not addressed the use of a hysteroscope when doing procedures to remove retained products of conception, but you might want to write to them to see what their take on this is. The diagnosis will be incomplete abortion, not missed abortion for the repeat. If the procedure had been done more than 90 days following the initial surgery, a member of the ACOG coding committee has recommended using either 58120 (Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)) or 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C) with a diagnosis of 639.xx (Complications following abortion and ectopic and molar pregnancy) and 677 (Late effect of complication of pregnancy childbirth, and the puerperium). Under ICD-9 Guidelines, the late effects code is reported when an initial complication of a pregnancy develops a sequelae requiring care or treatment at a future date. It may be used at any time after the initial postpartum period.

ICD-10: When your diagnosis coding system changes, you’ll report

• O02.1 (Missed abortion) instead of 632.
  
• O94 (Sequelae of complication of pregnancy, childbirth, and the puerperium) instead of 677.
  

For the ICD-10 codes that will replace the 639.xx category , you would have to refer to the physician’s notes for the specific complication as the ICD-10 guidelines do not currently address coding for retained products of conception following a missed abortion.