Wiki new practice of gynecology

[tassjohn32]

Hello,
We just opened and I'm in charge of billing and some coding in the office, the Dr. has done several outpatient procedures that need billing:

D&C hysteroscopy; polypectomy: she is wanting me to use 58120,58555,57500 is she correct and will there be a modifier used?
THL BSO: 58572 (b/c of the weight)

Also, she has been using ex. 99385 for an annual exam also 99203 when she finds a problem. When I bill I use modifier 25 on the e/m code 99203. Is this correct because some plans will pay and some say those codes mean the same thing and will not pay for those procedures on the same day?

 

[CodingKing]

You don't get to automatically bill a sick visit with the annual exam just because something is found. Also if procedurfe is done the same day that E&M is bundled into it.

58572 would not be billed for a polypectomy. Hysterectomy codes are chosed based on weight of Uterus
Diagnostic Scope is bundled into surgical scopes as well

Sounds like 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C

 

[tassjohn32]

You don't get to automatically bill a sick visit with the annual exam just because something is found. Also if procedurfe is done the same day that E&M is bundled into it.

58572 would not be billed for a polypectomy. Hysterectomy codes are chosed based on weight of Uterus
Diagnostic Scope is bundled into surgical scopes as well

Sounds like 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C

Ok, what if the insurance paid for both procedures? Will they ask for recoupment?

 

[CodingKing]

Ok, what if the insurance paid for both procedures? Will they ask for recoupment?

If hysterectomy was billed when it wasn't a hysterectomy, If any service is misreported you really have a duty to contact the payer and refund and not wait for them to discover it later. If government payer the quicker the better.