Ob-Gyn Coding Alert

Question: Can I report 58561 and 58563-59 together?

Florida Subscriber

Answer: Yes, you can. The Correct Coding Initiative (CCI) does not bundle 58561 (Hysteroscopy, surgical; with removal of leiomyomata) and 58563 (Hysteroscopy, surgical; with endometrial ablation [e.g., endometrial resection, electrosurgical ablation, thermoablation]).

When reporting these two codes together, therefore, you should not use modifier 59 (Distinct procedural service). You should only use this modifier when others are not more appropriate, such as modifier 51 (Multiple procedures), which you should use in this case.

     
Using modifier 51: You should apply modifier 51 to the lesser valued of the two procedures, according to their relative value units (RVUs) as assigned by the Medicare physician fee schedule. When performed in a facility setting, 58561 has 15.20 RVUs, and 58563 has 9.48. Therefore, you-ll apply modifier 51 to 58563.

Keep in mind: Medicare does not require modifier 51, but other payers might. You should check with your payers to learn their policy.