Ob-Gyn Coding Alert

Question: What would be the correct way to code laparoscopic-guided hysteroscopic resection of septum and lysis of adhesions? Should I use 58559 with modifier 22?

Arkansas Subscriber

Answer: No, you should not report 58559 (Hysteroscopy, surgical; with lysis of intrauterine adhesions [any method]) with modifier 22 (Increased procedural services) because this code represents only one of the procedures your ob-gyn performed. The removal of the septum has its own code, 58560 (Hysteroscopy, surgical; with division or resection of intrauterine septum [any method]). Note: The Correct Coding Initiative (CCI) does not bundle these two codes.

You may not get paid for the laparoscopic "guidance" in this case. The ob-gyn appears to need the guidance to ensure that the uterus is not ruptured during the hysteroscopic procedure. Most payers will not reimburse separately when that is the reason.  

However, if the ob-gyn needed to do a diagnostic laparoscopy, you will need a viable diagnostic code -- such as pelvic pain (625.9, Unspecified symptom associated with female genital organs).

If the ob-gyn had to do it because he suspected uterine laceration, you would use a complications code (for instance, 998.2, Accidental puncture or laceration during a procedure).