Wiki 58558

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Korbc said:
hey there

can someone refresh my memory, if no sampling or polyp removal are done but d&C is can i charge 58558 or only 58555?

thanks!
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Why was the D & C performed: obstetrical (e.g., miscarriage) or non-obstetrical?
Was the D & C performed hysteroscopically or non-hysteroscopically?
 
csperoni said:
The D&C is the sampling. D&C is scraping the lining of the uterus (endometrium). It does not need to be a separate polyp removal in order to use 58558.
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58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C

I don't understand, then, why the code would say “with sampling...with or without D & C”.

If the D & C is the sampling, then it is with D & C, and then, it is redundant. There would be no need for the last part: with or without D & C.

Clearly 58558 distinguishes between sampling and D & C. Likewise, medical literature, hence,

https://www.uptodate.com/contents/dilation-and-curettage-d-c-beyond-the-basics/print
In most cases, a health care provider will first try to sample the tissue of the uterus with an office procedure called an endometrial biopsy. If an endometrial biopsy is not possible or if not enough tissue is obtained, a D&C may be needed.
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Endometrial biopsy (sampling) is usually performed without anesthesia.
D & C is performed with some type of anesthesia.

Sampling removes a small piece of the endometrium.
D & C removes substantially more.

https://gynsurgicalsolutions.com/ch...red-a-dcpart-one-understanding-the-procedure/
Often, an endometrial biopsy is done before the D&C in your doctor’s office. Your doctor collects a small sample from the lining of your uterus (the endometrium) and sends it to a lab for testing. If the results show that more information is needed, your doctor may then move ahead with the D&C. While an endometrial biopsy removes just a sample of tissue, a D&C removes much more of the top layer of the uterine lining.
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(That article, too, emphasizes the distinction between sampling and D & C.)

Maybe 58558 is the best code there is even though it isn’t the most accurate.
shrugs
 
xXxPARAGONxXx said:
58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C

I don't understand, then, why the code would say “with sampling...with or without D & C”.

If the D & C is the sampling, then it is with D & C, and then, it is redundant. There would be no need for the last part: with or without D & C.

Clearly 58558 distinguishes between sampling and D & C. Likewise, medical literature, hence,

https://www.uptodate.com/contents/dilation-and-curettage-d-c-beyond-the-basics/print


Endometrial biopsy (sampling) is usually performed without anesthesia.
D & C is performed with some type of anesthesia.

Sampling removes a small piece of the endometrium.
D & C removes substantially more.

https://gynsurgicalsolutions.com/ch...red-a-dcpart-one-understanding-the-procedure/


(That article, too, emphasizes the distinction between sampling and D & C.)

Maybe 58558 is the best code there is even though it isn’t the most accurate.
shrugs
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I believe 58558 description is worded that way because you would use this code also if there is sampling less extensive than D&C, or polypectomy, with hysteroscope. I'm not stating that D&C and sampling are always the same. In this scenario described, the D&C is a type of sampling.
 
csperoni said:
I believe 58558 description is worded that way because you would use this code also if there is sampling less extensive than D&C, or polypectomy, with hysteroscope. I'm not stating that D&C and sampling are always the same. In this scenario described, the D&C is a type of sampling.
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In fact per the CPT Knowledge Base file:
We are often asked how to report a hysteroscopy and a dilation and curettage (D & C) performed at the same operative session. From a CPT coding perspective, a D & C performed at the same time as a hysteroscopy is reported using only code 58558, Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C.
The code was worded this way to make it clear that when sampling (biopsy or curetting) of the endometrium and/or polypectomy is performed, the D & C should not be coded separately. A dilation and curettage is so commonly performed with a hysteroscopy that it was decided to describe both of these procedures in a single code (58558).

It would not be appropriate to report a D & C and hysteroscopy performed during the same operative session with separate codes for each procedure (58120 for the D & C and 58555 for the hysteroscopy) since a code has been established that includes both procedures. For those times when it is appropriate to perform only a diagnostic hysteroscopy, then procedure code 58555 would be reported. Likewise, for those times when it is appropriate to perform only a diagnostic and/or therapeutic D & C, then procedure code 58120 would be reported. However, when both are performed during the same operative episode, only code 58558 would be reported.
 
nielynco said:
In fact per the CPT Knowledge Base file:
We are often asked how to report a hysteroscopy and a dilation and curettage (D & C) performed at the same operative session. From a CPT coding perspective, a D & C performed at the same time as a hysteroscopy is reported using only code 58558, Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C.
The code was worded this way to make it clear that when sampling (biopsy or curetting) of the endometrium and/or polypectomy is performed, the D & C should not be coded separately. A dilation and curettage is so commonly performed with a hysteroscopy that it was decided to describe both of these procedures in a single code (58558).

It would not be appropriate to report a D & C and hysteroscopy performed during the same operative session with separate codes for each procedure (58120 for the D & C and 58555 for the hysteroscopy) since a code has been established that includes both procedures. For those times when it is appropriate to perform only a diagnostic hysteroscopy, then procedure code 58555 would be reported. Likewise, for those times when it is appropriate to perform only a diagnostic and/or therapeutic D & C, then procedure code 58120 would be reported. However, when both are performed during the same operative episode, only code 58558 would be reported.
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Thank you. Definitely another thing I need to get a subscription for. (These sure do add up. :) )
 
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