Ob-Gyn Coding Alert

Question: My ob-gyn treated a patient they suspected had a possible molar pregnancy but was not confirmed by pathology. Should I report 59812? The op note states:

Procedure: Suction Dilation and Curettage

Anesthesia: Monitored Local Anesthesia with Sedation and Spinal

IV Fluids: 1000 mL of lactated Ringer’s

Estimated Blood Loss: 50 mL

Complications: None

Specimens: products of conception

Findings: Large Nabothian cyst on anterior cervical lip. Cystic structure within endometrium. Large amount of questionable products of conception vs molar pregnancy vs unknown evacuated from endometrial cavity. Endometrial stripe 6-7mm on ultrasound after procedure.

Procedure Details: The patient was taken to the operating room where IV sedation and spinal anesthesia was administered without difficulty. She was placed in the dorsal lithotomy position with legs in Allen-type stirrups. She was prepped and draped in the normal sterile fashion. A time-out was then performed.

An exam under anesthesia revealed the above findings. A weighted speculum was inserted into the posterior aspect of the vagina, and the anterior lip of the cervix was grasped with a single tooth tenaculum clamp. A hysteroscope was introduced and the cervix was dilated via hydrodistension. The above-mentioned findings were noted. The cervical os was then dilated with Hank dilators so an 8-mm curved suction curette could be introduced and advanced to the uterine fundus. The suction was then started. A moderate amount of tissue and products was evacuated with the curette rotating outward. The suction curette was removed, and gentle endometrial curettage was performed using a medium sharp curette. The suction curette was then reintroduced to clear the uterus of any remaining blood and products. The single tooth tenaculum clamp was removed from the cervix, and good hemostasis was noted. An ultrasound was brought into the room and the endometrial stripe was evaluated and noted to be 6-7 mm.

The patient tolerated the procedure well. All counts were correct times two. She was awakened from IV sedation anesthesia and taken to the recovery room in stable condition.

The patient will go home after recovering from anesthesia and meeting all the criteria for discharge.

PATH Uterus, uterine contents, curettage: Predominantly blood admixed with necrotic immature chorionic villi, consistent with products of conception. What should I report?

Michigan Subscriber

Answer: Immature chorionic villi signify an intrauterine pregnancy, so you would code this using 59812 (Treatment of incomplete abortion, any trimester, completed surgically) and use a diagnosis code for incomplete abortion, such as O03.4 (Incomplete spontaneous abortion without complication).

Despite the physician having used a hysteroscope, you should not report code 58558 (Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C) as it is meant for non-ob conditions.

While you might be tempted to report a diagnostic hysteroscopy (58555, Hysteroscopy, diagnostic (separate procedure)) with 59812, note that 59812 implies any method of surgical removal and already adequately values the use of the hysteroscope. If you compare the practice expense relative value units (RVUs) assigned to 59812 (3.56), 58558 (2.04) and 58555 (1.44) in a facility setting, you can see that 59812 already accounts for higher practice expenses (i.e., use of equipment) costs.