Ob-Gyn Coding Alert

Question: My coding dilemma is whether I should code for a D&C or a hysteroscopy when both are done in obtaining a biopsy. Some people in our practice think we should use only the D&C code 58120. Can you code for the 58120 alone and not use 56351 (hysteroscopy and biopsy with or without D&C)?

Kathie Cliffel, Medina County Ob/Gyn
Medina, Ohio

Answer: This is a great question because it highlights the ever-changing world of coding and the importance of being current and always coding correctly. In the past, the RVUs for 58120 (a D&C alone) were greater than those for 56351 (a hysteroscopy and biopsy with or without D&C). Some practices were reporting and billing only for the D&C (58120) to obtain the higher payment. Unfortunately, billing the 58120 only when a hysteroscopy was performed is considered unbundling and is never acceptable. Remember, reporting and billing falsely for higher payment is considered fraud. Regardless of the RVUs, correct reporting is always the only way to avoid trouble.

The good news is that, as of this year, the temptation to unbundle 58120 is gone, because today 56351 has an RVU of 7.18, while 58120 is now less valuable with an RVU of 6.53. So, when a D&C is performed in conjunction with a hysteroscopy and biopsy, you are correct in billing only 56351.