Wiki Laparoscopic presacral neurectomy

[melyrop1966@yahoo.com]

Hello,
Provider performed Laparoscopic presacral neurectomy on patient. We billed 58578 Unlisted and compared to 58410 which was denied. Does anyone have any advice on what code we should compare the work to? We are at a loss.
Any help would be appreciated,
Thanks,
Melissa

 

[nielynco]

Hello,
Provider performed Laparoscopic presacral neurectomy on patient. We billed 58578 Unlisted and compared to 58410 which was denied. Does anyone have any advice on what code we should compare the work to? We are at a loss.
Any help would be appreciated,
Thanks,
Melissa

First. what was the denial message. It could be that they consider the procedure investigational and therefore this is why you are getting a denial and the unlisted code you reported may have triggered this. But as background, you need to know the difference in coding depending on whether a presacral neurectomy or a uterine nerve ablation was performed. Presacral neurectomy and uterine nerve ablation are two surgical procedures that are used for patients who do not respond to medication and who continue to suffer from severe primary dysmenorrhea and/or chronic pelvic pain. Presacral neurectomy interrupts the sympathetic nerves of the uterus near the superior hypogastric plexus. As such, your unlisted code would be 64999 (there is no unlisted code for a laparoscopic procedure of the nerves). On the other hand, a laparoscopic uterine nerve ablation (LUNA) destroys uterine nerve fibers as they leave the uterus via the uterosacral ligaments and the unlisted code could be 58578, but a LUNA is almost always considered investigational by payers. Your comparison code is correct whether is was a presacral neurectomy or a LUNA. Since a presacral neurectomy was performed I would either resubmit with the corrected code or appeal the denial if done for medical necessity. A presacral neurectomy is generally considered medically indicated under the following conditions: the patient has midline (not lateral) pelvic pain unresponsive to medical therapy, which includes the following:
• A 3-month trial of oral contraceptives; or
• If oral contraceptives are contraindicated, menstrual suppression with progesterone or gonadotropin-releasing hormone (GnRH) agonist therapy