Ob-Gyn Coding Alert

Question: My ob-gyn did a dilation and curettage (D&C) as well as a hysteroscopy for retained products. The patient delivered six months ago. The uterus was perforated, and the doctor did a laparoscopic repair of perforation. How should I report this? Nevada Subscriber Answer: Unfortunately, you will find no clear coding solution here. The surgical treatment of an incomplete abortion or a postpartum D&C following delivery does not apply to this case, even if the path report indicates that the physician removed products of conception during the procedure. Your best bet is to report 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C) for the hysteroscopy because the patient delivered six months ago. However, you won't find a laparoscopic code for uterus repair. Therefore, you need to go with unlisted-procedure code 58579 (Unlisted hysteroscopy procedure, uterus).- Be sure to use ICD-9 code 998.2 (Accidental puncture or laceration during a procedure) with the laparoscopic repair.-That way, if the payer does not reimburse for fixing a problem the surgeon caused, the insurer can appropriately deny it. If the ob finds products of conception, for the hysteroscopy diagnosis you could use code 677 (Late effect of complication of pregnancy, childbirth, and the puerperium). Alternatively, you may report a diagnosis based on the findings or initial symptoms.