Ob-Gyn Coding Alert

Question: We are considering purchasing a hysteroscope for our offices. But if a patient has a diagnostic hysteroscope in the office and the physician feels that a dilation and curettage (D&C) is necessary in the OR, can we bill both? In other words, should we bill the diagnostic through the office and the hospital bill the D&C? Should we add modifier 78?

Montana Subscriber Answer: Yes, you can bill both using 58555 (Hysteroscopy, diagnostic [separate procedure]) for the diagnostic hysteroscopy. For the D&C performed later in the hospital, you should use 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), depending on whether the ob-gyn uses the hysteroscope again.
 
The modifier on the D&C will be 58 (Staged or related procedure or service by the same physician during the postoperative period), not 78 (Return to the operating room for a related procedure during the postoperative period), because the D&C is a more extensive procedure than the diagnostic hysteroscope and of course the patient is not being returned to the operating room, because the ob-gyn performed the first procedure in the office setting.