Ob-Gyn Coding Alert

Question: We scheduled a patient for a hysteroscopy dilation and curettage (D&C, 58558), but because of cervical stenosis, the ob-gyn perforated the posterior uterine wall. So she attempted a diagnostic laparoscopy (49320) to confirm. Due to the patient's size, however, the ob-gyn had to perform a laparotomy and cauterize the perforation. How should I code this? 


Idaho Subscriber


Answer: You should report 58558-52 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C; reduced services) and 49000-22 (Exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]; unusual procedural services) to cover the attempted laparoscopy and the cauterization.
 
Another option is to go with 58520-22 (Hysterorrhaphy, repair of ruptured uterus [nonobstetrical]; unusual procedural services) to cover the uterine repair and the attempted laparoscopy.

Either way, you must link these second procedures to 998.2 (Accidental puncture or laceration during a procedure). You can list V64.41 (Laparoscopic surgical procedure converted to open procedure) in addition. This links to the open code.

Remember: You won't likely receive reimbursement for 49320-52 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]; reduced services) for a diagnostic laparoscopy that failed when billed separately.