Ob-Gyn Coding Alert

" New methods for endometrial ablation are here or on the horizon, and although they promise relief for patients, they are bound to bring challenges to ob-gyn coders (see Know the Treatment Options for Endometrial Ablation"" - article 2). " What Is Dysfunctional Uterine Bleeding? Physicians often use endometrial ablation to treat dysfunctional uterine bleeding which is also known as menorrhagia the formal name for prolonged or excessive menstrual bleeding. In some patients the bleeding is so severe that it causes anemia. Current ICD-9 codes associated with this condition are 626.2 (Excessive or frequent menstruation) 626.4 (Irregular menstrual cycle) 626.6 (Metrorrhagia) 626.8 (Other) and 626.9 (Unspecified). Many things may cause this condition including a hormonal imbalance abnormal ovulation uterine trauma polyps fibroid tumors cancer cervicitis and other infectious conditions. Irritation from an intrauterine device may also cause menorrhagia or it may be a sign of an ectopic pregnancy. Coding the Related Services Until CPT 2001 only one procedure code existed for endometrial ablation. That code 58563 describes the use of a hysteroscope to accomplish the endometrial ablation. CPT added a second code 58353 in 2001 to describe the thermal balloon procedure which is accomplished normally without the use of the hysteroscope.

But how is the coder to know which code to use with the new techniques and what other services can be billed at the time of the procedure? "To begin identify the various types of services provided at the time of the endometrial ablation to see if any can be coded in addition to the procedure " says Melanie Witt RN CPC MA an independent coding consultant and educator based in Fredericksburg Va. All of the new techniques for endometrial ablation have cervical dilation in common. Because this is an integral part of the procedure you normally would not code it separately if performed at the time of the procedure. Some physicians however may elect to prepare the cervix in advance using a cervical dilator. You can report this procedure separately using 59200 (Insertion of cervical dilator [e.g. laminaria prostaglandin] [separate procedure]).

"Because this is a CPT 'separate procedure ' if the ob-gyn performed the cervical dilation on the same date as the ablation but earlier in the day and the physician has met the criteria for using this modifier modifier -59 (Distinct procedural service) should be added " Witt says. If the insertion took place the day before surgery you would not need to add a modifier. "Also note that because 59200 has a zero-day global period you would not need a modifier for the endometrial ablation code performed the next day either " she adds. The new methods for performing endometrial [...]