As an obstetrician-gynecologist (OBGYN), apart from providing healthcare services, you also want a secure source of income. It indeed becomes a great disappointment and a reason for stress when you receive a denial for your claims. We are here working tirelessly to reduce your stress, providing comprehensive guides on CPT codes.
Today’s blog discusses CPT code 58558, which represents surgical hysteroscopy with biopsy and D&C. Let’s explore the correct application of this code with practical examples and relevant billing guides.
CPT Code 58558 – Description
CPT code 58558 reflects a hysteroscopy procedure on the corpus uteri. It is a minimally invasive procedure. During this procedure, a gynecologist or any other healthcare professional inserts a tiny camera, called a hysteroscope, into the uterus through the cervix and vagina, enabling the physician to examine the uterus’s interior, remove polyps, biopsy the endometrial lining, and occasionally, if required, perform a dilation and curettage (D&C) to scrape the lining. The collected sample is then sent to the lab for pathological examination.
The technique treats several uterine disorders, such as endometrial hyperplasia, uterine polyps, fibroids, irregular bleeding, or thicker endometrial tissue, and other disorders. In addition to treating these problems, it also determines the origin of the symptoms.
Scenarios Where CPT Code 58558 is Applicable
Here you can read some applicable scenarios to understand the correct use of CPT code 58558.
Menorrhagia
Menorrhagia refers to heavy menstrual bleeding. This condition is quite common in menstruating women, and almost one-third of women look for its treatment. Let’s see how it can be treated by surgical hysteroscopy.
Suppose a 25-year-old woman comes to your clinic with some issues with her periods. She tells you that her periods last longer than usual, with excessive bleeding, and she has to change her pad or tampon every hour. Sometimes she has to layer up her pad to avoid the leakage. The most concerning part is that her recent test reports do not give any signs of PCOS or thyroid disease. You perform a hysteroscopy to find out the reason for heavy bleeding by inserting a thin, lighted tube to see inside the uterus. Upon detecting polyps, you remove them with surgical instruments as they were the cause of heavy bleeding. In this scenario, you can charge the service using CPT code 58558.
Endometrial Polyps
Uterine polyps are quite common in women in their 40s and 50s. So, think about a scenario where a 56-year-old woman who is in her menopause experiences sudden vaginal bleeding. Her ultrasound reports reveal that she has developed endometrial polyps in her cervix. The physician performs a hysteroscopy where she inserts a long, thin, lighted tube (hysteroscope) into the cervix to examine and remove the polyps. The physician performing this procedure can apply CPT code 58558 to bill for her services.
Structural Uterine Abnormalities
Consider a woman who has had three miscarriages in a row. She discusses this matter with her gynecologist. The gynecologist performs a hysteroscopy to determine the underlying cause of miscarriages. The hysteroscopic imaging reveals an increase in the lining of the uterus. She decides to use surgical tools to remove this excess uterine lining. Therefore, she can bill this procedure under CPT code 58558.
Applicable Modifiers for CPT Code 58558
The following are some of the applicable modifiers for CPT code 58558.
Modifier 22
Modifier 22 is used to report increased services. In the case of CPT code 58558, if the physician is performing services that involve substantially greater work than typically required, such as removing a huge, difficult polyp, he can bill his services with this modifier. The coding will look like: 58558-22
Modifier 53
Modifier 53 refers to a discontinued service. Physicians can report this modifier with CPT code 58558 if they have to discontinue the service after anesthesia administration due to a potential health risk for the patient.
CPT Code 58558 – Billing & Reimbursement Guidelines
Let’s discuss some essential billing and reimbursement guidelines for CPT code 58558.
Submit Proper Documentation
Proper documentation plays a significant role in correct reimbursement. There are a few key details that your paperwork must convey to the insurance payer. This information includes:
- The complete patient information and history
- A clear justification for the necessity of the procedure.
- The relevant ICD-10 diagnostic codes
- A detailed report of collected endoscopic observations
- The sizes and locations of the polyps (if any)
- The precise biopsy site and the duration of the procedure
Be Wary of Global Surgery Days
Surgical hysteroscopy is considered a minimally invasive procedure. So, the global period for this code is 0 days. This means that the insurance payer will not cover the pre- and post-operative services even if they are provided on the same day. You must bill such services separately.
Bundling with CPT code 58555
Most physicians get confused when they perform a diagnostic hysteroscopy with a surgical hysteroscopy. The first approach that comes to their mind is to separate these procedures with modifier 59, which is absolutely wrong. According to an NCCI edit, you can bundle CPT code 58555 (Diagnostic hysteroscopy) into CPT code 58558 (Hysteroscopy, surgical with or without D&C), indicating that these codes should not be billed together by the same provider for the same patient on the same day. Since diagnostic hysteroscopy is a part of the surgical process, you will only report CPT code 58558.
Final Word
We hope that this guide has given you sufficient to bill CPT code 58558 with confidence. But before we take your leave, let’s quickly recap this code’s key details. It represents a surgical hysteroscopy with a biopsy of the endometrium or polypectomy, with or without D&C. You may use this code when a hysteroscopy is used to remove polyps or excessive uterine lining. You may also use modifiers like 22 and 53 when the situation demands it. Lastly, you must stay vigilant while documenting the procedure and bundling and unbundling the code.
If you are still confused or tired of the constantly shifting payer regulations, consider connecting with a company that offers professional OBGYN billing services. They can help you manage your billing, increase your collections ratios, and improve your bottom line.
