TME, Somehow I feel it is not fair to just code Hysterectomy and get away with that.
The hysterctomy was not the intended procedure at the out set.
It invloved very extensive journey of D&E, then myomectomy which itself is an extensive, cumbersome and time consuming major procedure and please note it was undertakenas an emergency procedure to contro bleeding, and when the bleeding not controlled with this also, hysterctomy was carried out as a life saving measure.
I feel that this myomectomy need to be reported by all means separately with modifier -59;
If not allowed, atleast needs to be addressed with mod-22 with a detailed report of the myomectomy procedure.
Well the D&E, explor.laparotomy, Curettage all would be bundled in to the major procedure.
Thirdly, cystoscopy is not a component or integral part of hysterectomy.
it is underatken as a final separate and distinct procedure to verify the other organ is not injured. It also needs to be reported separately.
To sum up,I feel ( my school of thought) that it needs three code assignments: hysterectomy code , myomectomy code with -59 and -22, and diagnostic cystoscopy code.
It may not be acceptable but I feel it is justified when it is presented with pertinent and detailed report from the Physician.
Thank you