Failed hysteroscopic D&C procedure

Q One of our physicians attempted a hysteroscopic dilatation and curettage (D&C), but several attempts at cervical dilation were unsuccessful. The physician abandoned the procedure and proceeded with a traditional D&C. Should we use the code 58558 with the modifier-53, plus the code 58120?

A There are 2 problems with your suggested coding. First, the code 58120 (D&C) is included in the code 58558 (hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C) and would likely be denied by the payer as a bundled service. Second, the modifier-53 is used only when a procedure is completely stopped due to the patient’s condition, e.g., fall in blood pressure, and she is sent home or to the recovery room.

In this case, you abandoned the first procedure and began and completed a second procedure. If this were a Medicare patient, you would be allowed to bill only for the second procedure. Other payers may allow you to also bill for the “failed” procedure, especially if your documentation shows significant work. To do this, you might want to bill for the traditional D&C (58120) and add the modifier-22. As always, be sure to send documentation with the claim.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q One of our physicians attempted a hysteroscopic dilatation and curettage (D&C), but several attempts at cervical dilation were unsuccessful. The physician abandoned the procedure and proceeded with a traditional D&C. Should we use the code 58558 with the modifier-53, plus the code 58120?

A There are 2 problems with your suggested coding. First, the code 58120 (D&C) is included in the code 58558 (hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C) and would likely be denied by the payer as a bundled service. Second, the modifier-53 is used only when a procedure is completely stopped due to the patient’s condition, e.g., fall in blood pressure, and she is sent home or to the recovery room.

In this case, you abandoned the first procedure and began and completed a second procedure. If this were a Medicare patient, you would be allowed to bill only for the second procedure. Other payers may allow you to also bill for the “failed” procedure, especially if your documentation shows significant work. To do this, you might want to bill for the traditional D&C (58120) and add the modifier-22. As always, be sure to send documentation with the claim.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q One of our physicians attempted a hysteroscopic dilatation and curettage (D&C), but several attempts at cervical dilation were unsuccessful. The physician abandoned the procedure and proceeded with a traditional D&C. Should we use the code 58558 with the modifier-53, plus the code 58120?

A There are 2 problems with your suggested coding. First, the code 58120 (D&C) is included in the code 58558 (hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C) and would likely be denied by the payer as a bundled service. Second, the modifier-53 is used only when a procedure is completely stopped due to the patient’s condition, e.g., fall in blood pressure, and she is sent home or to the recovery room.

In this case, you abandoned the first procedure and began and completed a second procedure. If this were a Medicare patient, you would be allowed to bill only for the second procedure. Other payers may allow you to also bill for the “failed” procedure, especially if your documentation shows significant work. To do this, you might want to bill for the traditional D&C (58120) and add the modifier-22. As always, be sure to send documentation with the claim.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.