Wiki hysteroscopy x 2 with thermal ablation

[dkaz1]

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Hi All:

I've got a tricky one here--

The patient was being treated for menorrhagia and desired permanent sterilization

Briefly, the Op note states

a laparoscopic LT salpingectomy (RT was removed years ago)-- I used CPT 58671-LT

then, a diagnostic hysteroscopy was performed--findings were that the endometrium was thickened preventing clear visualization, so the hysteroscope was withdrawn then a D&C was performed-specimens went to Pathology; then the Novasure device was inserted and ablation was performed; the device was removed and then the hysteroscope was reinserted to inspect the results of the ablation then the hysteroscope was withdrawn with the procedure(s) being terminated.

My coding issue is the fact that the hysteroscope was used twice during this procedure, but not used for the Novasure/thermal ablation procedure. I've been instructed to code the Novasure/thermal ablation with CPT 58353.

I can understand coding the ablation procedure w/o the hysteroscopy--however, the hysteroscope was used twice during the entire operative period.

CCI edits include the D&C with the ablation procedure so I would not code the D&C separately.

Should I be coding the hysteroscopy only once as a diagnostic hysteroscopy CPT 58555 as the second time the hysteroscope was used was to inspect the outcome of the ablation? OR should I code the ablation procedure with the hysteroscopy using CPT 58563?

I am coding for the facility and want to be sure that the use of the hysteroscope is captured.

Any input is greatly appreicated.

Debbie K

 

[nsteinhauser]

I use the 58563. The Novasure needs to be in 100% contact with the endometrium to work so you couldn't have the hysteroscope inserted at the same time. You're still using 'hysteroscopic guidance' by using the hysteroscope before and after. And you are correct - the D+C and the diagnostic hysterosocpy are all included in the 58563 code. Hope that helps.

 

[bench]

Normally when you do a hysteroscopic d & c the md will insert the scope first to check the endo lining then remove the scope and do the d&c afterwards the scope will be reinserted again to check uterine lining to determine if the d&c was enough. In this case you will not code 58558 and 58555 as the reinsertion of the scope was part of the d&c. But in your case hta was aslo done which will make the d&c inclusive. Since hystercopy was involve i would code it 58563 too. Hope this helps you.