CPT 58559 will be reported to the surgical hysteroscopy with lyses intrauterine adhesion, no matter what method is applied. It is usually done as a remedy to intrauterine scar tissue which may disrupt menstruation, fertility or pregnancy.
To have accurate coding, the adhesions, surgical treatment of the hysteroscope, and the method of cutting or excising the scar tissue have to be documented.
The official CPT description is:
Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method).
In this process, a doctor puts a hysteroscope up through the cervix in order to see inside the uterus. A technique that is either synechia or intrauterine adhesions are then separated or excised using proper surgical method.
Depending on the clinical situation, the physician may use:
It is often used in the management of intrauterine adhesions and Asherman syndrome, especially when scar tissue involves in the causes of amenorrhea, infertility or frequent pregnancy loss.
Report CPT 58559 in the case of performing surgical hysteroscopy and lysis of intrauterine adhesions by the physician.
Documentation should support:
The code is applicable of whichever type that was applied to lyse the adhesions, as long as the service recorded complies with the CPT descriptor.
CPT 58559 is not to be reported in a situation where the performed service is not a surgical treatment of intrauterine adhesions.
Do not use 58559 when:
CPT 58559 When diagnostic hysteroscopy is done within the preparative of surgical hysteroscopy, it is not reported separately.
The surgical hysteroscopic procedure includes the diagnostic examination. Hence, coders must not necessarily include CPT 58555 when 58559 is included just because the physician has documented an investigations on the uterine cavities.
Reporting of modifiers is an occasion that depends on the circumstances of the encounter to meet the relevant CPT and payer conditions.
Modifier 22 can be taken into consideration as a situation whereby the lysis of adhesions involves a significantly higher amount of work than is normally related to CPT58559.
Examples would be in cases where adhesions are abnormally so large or thick and therefore demand much more surgical work.
The operative report ought to contain an explanation of the situations that resulted in the extra work. The fact that the procedure was merely a challenge is normally not sufficient justification in encouraging more procedural services.
Since CPT 58559 has a 0-day global period, an E/M service done on the same date has a potential of being reportable separately in a case where it is significant, separately identifiable, and otherwise meets the relevant documentation requirements.
A modifier 25 can be used when there is a difference in the E/M service and normal preoperative or procedural service that are part of the hysteroscopy.
Modifier 59 might apply when there is a separate reportable procedure and documentation that identifies another service.
It must not be added merely in order to avoid a NCCI edit. Before a coder reports a number of hysteroscopic procedures in a single time frame, he/she must consult the NCCI edits and payer policies that might be relevant.
With the help of payer requirements, a proper X modifier can be applied when it is necessary to specify a more specific unique circumstance of the procedure than does a modifier 59.
The payer who is being billed should have the specific modifier and reporting requirements checked.
An effective operative report must lay down the clinical and procedural components in favour of 58559.
Documentation should include:
CPT 58559 is typically associated with 58559 0-day global period, in the sense that it does not do as extended a postoperative global period as many highly traumatic surgical procedures.
Reimbursement varies according to:
A hysteroscopy is done on a patient with intrauterine adhesions. The doctor determines thick synechial and separates the adhesions with hysteroscopic scissors.
Report CPT 58559.
The documentation supports surgical hysteroscopy with lysis of intrauterine adhesions.
Hysteroscopy is performed when a patient is evaluated in case of abnormal uterine bleeding. No surgical intervention is performed, and no adhesions are found.
CPT 58559 is not appropriate.
A diagnostic hysteroscopy code should be evaluated instead.
The doctor conducts hysteroscopy, observes the inside part of the uterus, detects intrauterine adhesions, and removes them surgically.
Report CPT 58559.
The diagnostic examination is included with the surgical hysteroscopy, which is not reported separately as CPT 58555.
Hysteroscopy and resection of a congenital intrauterine septum by the physician.
CPT 58560 needs to be considered compared to 58559 since the procedure would require the division/resection of the septum but not the lysis of the adhesions.
A patient is severely intrauterine adhesive and needs considerably more surgical intervention than would be anticipated. The doctor records the presence of impressive scar tissue, longer dissection time, and massive workload.
CPT 58559 will stay as the main procedure code with the modifier 22 will be considered when the documentation displays the substantially higher procedure services.
CPT 58559 claims may be complexed in case of adhesiolysis that are done in conjunction with other hysteroscopic services. The services provided by CureCloudMD in the field of OBGYN medical billing are to assist the practices in the review of the procedure, documentation, modifiers, and claim edits performed by the practice prior to submission.
CureCloudMD can support practices with:
CureCloudMD may also track some of the key revenue-cycle indicators, and a denial-rate should be below 1% as an internal performance goal instead of an actual guarantee that the outcome can be achieved.