Ob-Gyn Coding Alert

Question: I have a question regarding coding a nonobstetrical D&C (58120) and endometrial ablation (58563). My doctor thinks they should be billed separately. Is she right?


Virginia Subscriber


Answer: The National Correct Coding Initiative bundles 58120 (Dilation and curettage, diagnostic and/or therapeutic [nonobstetrical]) into 58563 (Hysteroscopy, surgical; with endometrial ablation [e.g., endometrial resection, electrosurgical ablation, thermoablation]).
 
You can use modifier 59 (Distinct procedural service), however, to bypass the edit if the D&C was not integral to and the ob-gyn did not perform it for the same reason as the endometrial ablation.

Most payers will deny your D&C claim because the ablation removes or destroys the endometrium, and dilation and curettage removes the endometrium. For that reason, payers consider the ablation and the D&C to be integral to each other when the ob-gyn performs them together.

Note: This rationale is also why the National Correct Coding Initiative permanently bundles 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C) into 58563.

This means you cannot separate this pair with a modifier under any circumstances. NCCI also bundles a D&C into 58353 (Endometrial ablation, thermal, without hysteroscopic guidance). You won't be able to use a modifier to bypass this edit either.