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Ob-Gyn Coding Alert

You Be the Coder:

Apply Either Modifier 51 or 59 In This Essure Scenario

Published on Tue Oct 04, 2011

Question: The doctor stopped the Essure procedure he was performing in our office. According to his documentation, he couldn't visualize due to uterine distention. He said that he did a diagnostic hysteroscopy and then ended up inserting a ParaGuard. He also said that nothing he did for the Essure procedure would be included in the ParaGuard. I've checked the Correct Coding Initiative (CCI) edits, and they are not bundled. How should I report this? Should I apply modifier 53?Kentucky SubscriberAnswer: At best, you can report 58565-52 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants; Reduced procedural services) and 58300 (Insertion of intrauterine device [IUD]) with either modifier 51(Multiple procedures) because the ob-gyn performed this service at the same time as the hysteroscopy or modifier 59 (Distinct procedural service) because this service was distinct from the Essure attempt.Alternatively, you could try billing a diagnostic [...]
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