Ob-Gyn Coding Alert

Question: My ob-gyn performed a hysteroscopy with dilation and curettage and sampling for histopathologic examination. Then he did an open laparoscopy and found dense anterior wall adhesions (lysis of adhesions). The procedure turned into a laparotomy due to multiple fibroids and non-visualization of adnexa. He attempted chromopertubation to determine if tubal patency was present due to previous myomectomy, and he documented no spillage. He did remove an 8-cm fibroid and a 5-cm fibroid. He closed the uterine wall, then removed several subserosal fibroids ranging from 2.5 cm to 5 cm. He performed chromopertubation again. There was no spillage, so he placed a Hume manipulator with a balloon. What is the best way to code these procedures?


Vermont Subscriber

 
Answer: You should code the hysteroscopy with D&C using 58558-51 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C; multiple procedures). You should use the open myomectomy code, 58140 (Myomectomy, excision of fibroid tumor[s] of uterus, 1 to 4 intramural myomas[s] with total weight of 250 grams or less and/or removal of surface myomas; abdominal approach), with modifier 22 (Unusual procedural services) for converting the procedure from an open laparoscopic to an open abdominal procedure and to account for the extensive lysis of adhesions.

Note: Most payers will not reimburse for the lysis of adhesions unless the documentation supports significant work in removing them. If you tried to use a separate code (such as 58740, Lysis of adhesions [salpingolysis, ovariolysis]), you-d be facing a denial because of bundling issues. 

You can also bill the chromotubation (58350-51, Chromotubation of oviduct, including materials) because the ob-gyn performed this procedure initially for the diagnosis of the blockage, but you should not include the second chromotubation procedure because it was done to check the surgeon's work.