Wiki 59400 & 59160 on same date of service

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bsrinivasarao777

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I am little confused on below one…..

Curettage was done at the time of vaginal delivery with the intention to treat postpartum hemorrhage on same date. In this case claim has coded with 59400 & 59160. Finally claim got denied the CPT 59160 as inclusive.
Our superior is telling that CPT 59160 needs to be coded when the patient returning back or next follow up visit (postpartum-care visit) not at the time or same date of delivery.

E.g; Patient got delivered on 11/19/2015 and returning back on 11/30/2015 for curettage.

I am not sure if this is the correct way to code…Thank you.
 
bsrinivasarao777 said:
I am little confused on below one…..

Curettage was done at the time of vaginal delivery with the intention to treat postpartum hemorrhage on same date. In this case claim has coded with 59400 & 59160. Finally claim got denied the CPT 59160 as inclusive.
Our superior is telling that CPT 59160 needs to be coded when the patient returning back or next follow up visit (postpartum-care visit) not at the time or same date of delivery.

E.g; Patient got delivered on 11/19/2015 and returning back on 11/30/2015 for curettage.

I am not sure if this is the correct way to code…Thank you.
Click to expand...

There is no CCI edit for those codes so you should be able to bill them together. What diagnosis code did you use for the 59160 - one for post-partum hemorrhage? I would try to resubmit with a 59 modifier on the 59160. I definitely would not bill for a procedure on a different day than the day that it was done! That is fraud! If the procedure was done on 11/19, than it has to be billed with that date - whether it will be paid or not!

Hope that helps!
 
Hi,
Jodi Dibble......,

Here based on the documentation i have billed the claim with CPT 59400 & CPT 59160 (Curettage done at the time of normal delivery to treat hemorrhage for the same DOS), but CPT 59160 got denied as inclusive with Global Ob service and rep is telling that the CPT 59160 could not bill separately with CPT 59400. So I have doubt when to bill the CPT 59160 with CPT 59400.
Could you provide a clear clarification on CPT 59160?
Share your suggestion on above mentioned scenario……

Thank you
 
bsrinivasarao777 said:
Hi,
Jodi Dibble......,

Here based on the documentation i have billed the claim with CPT 59400 & CPT 59160 (Curettage done at the time of normal delivery to treat hemorrhage for the same DOS), but CPT 59160 got denied as inclusive with Global Ob service and rep is telling that the CPT 59160 could not bill separately with CPT 59400. So I have doubt when to bill the CPT 59160 with CPT 59400.
Could you provide a clear clarification on CPT 59160?
Share your suggestion on above mentioned scenario……

Thank you
Click to expand...

From what I see in regards to this code, it seems to be a code that IS to be used directly following delivery. The following is the description of the procedure copied from Supercoder as well as a Q & A in regards to correct code usage:

Lay Term

The provider scrapes the endometrial lining of the uterus following childbirth. The provider performs this procedure using a vaginal approach.

Clinical Responsibility

The provider places the patient in the lithotomy position and administers a regional, general, or local anesthetic. The provider inserts a weighted speculum into the vagina, and cleanses the cervix with an antiseptic solution. He then grasps the cervix with a tenaculum and uses a long, flexible instrument, called a uterine sound, to determine the size and position of the uterus. The provider then inserts a blunt, or banjo, curette into the endocervical canal and enters the uterine cavity to carefully scrape out the retained products of conception that are causing the patient to bleed following birth.

If this procedure is done following a cesarean delivery, the provider dilates the cervix before performing the curettage. The provider then removes the instruments and ensures that there is no additional bleeding and treating any lacerations.


Question: If a patient came back eight weeks after she delivered for dilation and curettage for retained products of conception, should we use 59160? Or can we only use this code right after delivery (during the same episode of care)?


Answer: At eight weeks, you should report 58120 (Dilation and curettage, diagnostic and/or therapeutic [nonobstetrical]) because the cervix is closed, and the patient will need dilation.

Code 59160 (Curettage, postpartum) is more relevant after delivery and during the same episode of care while the cervix is still dilated.

59160 is not a normal procedure performed with every delivery so I would think that it should not be included in code 59400. Did you submit the claim with a 59 modifier on 59160? Maybe resubmit with the modifier. Maybe this is a policy of the insurer...check with them to see why they are denying this as I found no CCI edit for these 2 codes! You could try an appeal if the 59 modifier doesn't work, however, either way, of course, you cannot bill for the curettage on a different date of service than when it was performed.

Hope this helps!
 
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