Wiki Hysteroscopy with removal of dislodged Paraguard IUD arm

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MaureenDL123

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Patient scheduled for a hysteroscopy D&C for post menopausal bleeding and possible polyp. While the procedure was being performed, no polyp was seen, but patient had a history of Paraguard IUD arm embedded in one of the uterine walls. During the hysteroscopy the water pressure dislodged the arm which floated to the fundus and a grasper was inserted through the hysteroscope and removed the arm. Hysteroscope removed and sharp currette performed. Would you still code this as 58558 or does it now become 58562 with 58120?

Thank you in advance.
 
MaureenDL123 said:
Patient scheduled for a hysteroscopy D&C for post menopausal bleeding and possible polyp. While the procedure was being performed, no polyp was seen, but patient had a history of Paraguard IUD arm embedded in one of the uterine walls. During the hysteroscopy the water pressure dislodged the arm which floated to the fundus and a grasper was inserted through the hysteroscope and removed the arm. Hysteroscope removed and sharp currette performed. Would you still code this as 58558 or does it now become 58562 with 58120?

Thank you in advance.
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I would only bill 58558. This was like an "oops" while performing the intended procedure and I would not try coding separately for it. There is no real provider work involved in removing an imbedded IUD arm as it was done passively. And a basic rule under CPT guidelines is that if you insert a hysteroscope you report the procedure for the hysteroscopic approach even if it is removed during the procedure so 58120 would never be correct. There is not enough work here that would support the use of a modifier -22 either in my opinion.
 
I agree with Melanie. If the reason the hysteroscope was performed was with the intent to dislodge the imbedded IUD arm, then 58562 might be more appropriate. This sounds like "Hey, whadda ya know? There's a part of an IUD..."
If the full op note supports additional work, you could consider -22, but it doesn't seem like appropriate here.
 
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