Ob-Gyn Coding Alert

Question: When billing myomectomy, if the myomas are not intramural but the weight is greater than 250 grams, can you still report 58146 or 58546? If the myomas were a combination of intramural, submucous, subserosa and total over 5 or more, can you report 58146 or 58456?

Massachusetts Subscriber

Answer: You must have a confirmed diagnosis of an intramural fibroid to report 58146 (Myomectomy, excision of fibroid tumor(s) of uterus, 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g, abdominal approach). A statement in the operative note that the fibroid is “located on the lower segment” does not tell us this. As such, you should always look at the path report for confirmation of an intramural fibroid – both for their number and weight. A fibroid is only defined as intramural if it was mainly within the myometrium and did not impinge into the uterine cavity.

To qualify for 58146 or 58546 (Laparoscopy, surgical, myomectomy, excision; 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g), the patient must have 5 or more intramural fibroids or a total  weight of 1-4 intramural fibroids that is more than 250 g. Removal of surface myomas is not dependent on weight or number, but approach. You cannot combine the weight or number of different fibroid types to bill 58146 or 58546.