Wiki Hysteroscopy with Endometrial Ablation and D&C

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tjcornman

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How is everyone coding a hysteroscopy with endometrial ablation and D&C. There is a cci edit that states these two codes 58558 and 58563 cannot be coded together. From research I have gathered online, the D&C is needed to scrape that problem tissue away before doing the ablation or the ablation will not work. Could anyone assist me with this? It happened to be my own chart and when I called the physician's office they are trying to say it was two separately identifible procedure and are putting a -59 modifier on it. The hospital where the procedure was performed agrees with me to only code 58563. Also a few other hospitals also agree that they are coding it incorrectly. I need help.
 
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To: butterflygirl2j RE:Hysteroscopy with Endometrial Ablation and D&C

Our physicians perform a diagnostic Hysteroscopy first which they do not bill for. They remove the scope and perform the D&C (CPT Code 58120) when indicated. After the D&C they introduce the Hysteroscope again and perform the ablation (CPT Code 58563 and append it with a modifier 58 for staged procedure). This is acceptable per CCI.

Col1 Col2 Effective
Date Acceptable with Modifier?
58563 58120 06/05/2000 Yes
With these procedures, modifiers can be used in special cases to justify that both procedures can be used and billed together. Modifiers that can be used in this situation are:
Anatomical: E1 - E4, FA, F1 - F9, LC, LD, RC, LT, RT, TA, T1 - T9,
Other: 25, 27, 58, 59, 76, 77, 78, 79, 91

Hope this helps.
 
M.J. There is a CPT Assistant from 2003 that you need to look at.
It states how should a hysteroscopy followed by a D&C (not performed through the scope)be coded? The answer it gives is 58558. Please review this then tell me what you think. So you would be incorrect according to the instructions from the CPT assistant. I agree with the others with the 58563. From what I understand is the D&C has to be done to scrape the tissue away for the ablation to work properly. Its like painting walls without wiping the cobwebs off.
 
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