Ob-Gyn Coding Alert

Question: I'm confused about what CPT^® code(s) I should submit with the following claim: Dilation of the cervical canal done followed with hysteroscopy. Both ostia were seen (we did have some difficulty with visualization through that scope, but at the end both ostia were seen), and attempted to push in the Essure through the right tube. Half of the Essure went into the tube, and then we could not push it any farther. Suggestive of either tubal occlusion or spasm. We tried for a good period of time from different positions and movement of the uterus and the scope but this failed at the end. The procedure was aborted, and we decided to proceed with a laparoscopic bilateral tubal cauterization. Uterine manipulator was then put in. Anesthesia then decided to intubate the patient, and the nurse anesthetist and Dr. tried to do that. They were not successful so the procedure was aborted for safety procedure. The uterine manipulator was removed, and patient was taken to recovery. What should I submit? California Subscriber Answer: You should report 58565-52 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants; Reduced services) for the failed Essure procedure. Normally, if the procedure fails just after surgical prep and anesthesia induction due to a problem that threatens the well-being of the patient, and all surgery is stopped, modifier 53 (Discontinued procedure) would apply. But in this case, the physician did considerable work in attempting the procedure, and a modifier 52 is more in keeping with the work he performed. Also, modifier 53 requires that all surgery is stopped and the patient either goes to recovery or home. The use of modifier 53, in addition, will generally result in lower reimbursement than when you report modifier 52. Payers will most likely forgo paying you anything for the attempted laparoscopic bilateral tubal cauterization, as it appears the anesthesia induction was not successful. That means the physician did not even begin the procedure.