any insight on code 58580
OB/GYN
NY
OB/GYN
NY
-
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Wiki 58580
- Thread starter klapetri@ilovemygyn.com
- Start date
nielynco
True Blue
As in what do you need insight about? Coverage? The procedure requirements? Per the vignette used to add this code to CPT:
"
typical patient: A 38-year-old female presents with heavy menstrual bleeding for 6 months. Examination reveals an eight-week sized uterus. A human chorionic gonadotropin (hCG) test is negative and endometrial biopsy is normal. Transvaginal sonogram reveals multiple fibroids, the largest of which is a 5.2-cm x 4.5-cm x 4.6-cm transmural myoma.
pre service info: Perform preprocedure H&P and/or update. Review and update all laboratory tests as necessary. Counsel patient about the procedure and obtain informed consent. Confirm all necessary equipment is available in the operating suite and notify associated personnel. The surgeon completes standard surgical scrub and dressing procedures. When anesthesia has taken full effect, place the patient in the dorsal lithotomy position, prepared and draped in sterile fashion. Perform a pelvic examination while the patient is under anesthesia and place an indwelling catheter into the bladder.
intra service info: Place a bi-valve speculum within the vagina and visualize the uterine cervix. Position a tenaculum on the anterior lip of the cervix and dilate the cervix to 27F. The radiofrequency handpiece, handpiece cable, and intrauterine ultrasound probe clip together to create the transcervical fibroid ablation (TFA) device (forming a single component). After adequate cervical dilatation has been achieved, insert the TFA device transcervically into the uterus. Infuse a small volume of fluid such as sterile water through the device for acoustic coupling to enhance ultrasound visualization. Leiomyomata are then visualized with the integrated intrauterine ultrasound (IUUS) probe and mapped in a systematic fashion within the uterus. Mapping with the IUUS probe is an integral and required step to view and confirm the number and location of fibroids as well as to identify other critical structures. After identifying which fibroids to treat and articulating the IUUS probe, use the graphical overlay to target and plan ablations in the fibroid. Once the size, angle, and location of the ablation have been established, advance a trocar-tipped introducer into the fibroid under guided IUUS visualization. Align the graphical overlay with the introducer tip and, as the IUUS probe rotates independently of the introducer and needle electrodes, perform an initial safety rotation by rotating the IUUS probe 360° around the introducer. Then deploy the needle electrodes, again completing a second safety rotation to confirm the position of the thermal safety border relative to the uterine serosa. After the thermal safety border has been confirmed to be within the uterine serosal margin in all adjacent ultrasound planes, activate the radiofrequency (RF) energy. During this and any subsequent ablation, monitor the status of the RF generator and hold the TFA device steady throughout the ablation time. Each treated fibroid will receive one or more ellipsoidal ablations to achieve durable symptom relief. Repeat targeting and treatment steps as required to place any additional ablations in the same fibroid (if necessary) and/or treat any additional fibroids that were previously mapped. Upon completion of the procedure, retract the needle electrodes and introducer, articulate the ultrasound to zero, and remove the TFA device. Remove the cervical tenaculum and observe the tenaculum site for bleeding. Then remove the vaginal speculum and end the procedure.
post service info: Take the patient out of the lithotomy position and place in the supine position. Monitor the patient hemodynamically. Counsel the patient and family/caregiver regarding the procedure. Dictate operative note and complete postoperative orders. The patient is typically discharged on the date of service. One postoperative visit takes place with associated documentation and orders as indicated.
Coverage will depend on the payer as this was until Jan. 2024 a Category 3 CPT code which would be considered investigational by most payers. Now that it is CPT Category 1 code, those that were not paying for it might have changed their minds. Check with your payer policy and if it has been denied you should ask your provider to draft an appeal based on the medical indication for the patient.