Dilation and curettage (D&C) is one of the most frequently performed invasive procedures in the United States. Usually, this procedure is conducted on both pregnant and non-pregnant women. However, CPT code 58120 exclusively deals with non-obstetric D&C for diagnostic and/or therapeutic purposes.
In today’s guide, we have attempted to cover every crucial information that you must know and consider before submitting claims with this code. We will walk you through the official description of the code, applicable scenarios and modifiers, and finally, the billing and reimbursement guidelines. So let’s get started!
CPT Code 58120 – Description
CPT code 58120 describes the surgical procedure where the healthcare provider expands the cervix to access the uterine cavity for the purpose of scraping the uterine lining, either to address excessive bleeding or to collect a substantial tissue sample.
The provider may initially carry out this procedure for diagnostic purposes, which may also become therapeutic. D&C is employed to treat issues such as abnormal uterine bleeding, uterine polyps, and fibroids, or for endometrial biopsies.
Scenarios Where CPT Code 58120 is Applicable
Let’s move on to some real-life examples that will clarify when CPT code 58120 applies.
Diagnosis of Uterine Cancer
Suppose a 55-year-old woman suffers from vaginal bleeding even 3 years after her menopause. She visits her physician with the same concern. The healthcare provider suspects that, according to her complaints and symptoms, she might have uterine cancer. So she decides to surgically dilate the opening of your uterus, where it meets the top of the vagina, and then collect tissue from the inner walls of the uterus. The tissue will now be sent to the laboratory for testing to determine if cancer cells are present. Hence, she can apply CPT code 58120 to bill her services of D&C.
Uterine Polyps
Consider a second instance in which a 28-year-old woman experiences heavy menstrual bleeding. After an initial checkup, the physician suspects uterine polyps in the endometrium. So, he chooses to perform a dilatation and curettage surgery to scrape a deeper and larger tissue sample. He then sends this sample to the laboratory for further diagnosis. Diagnostic D&C services can be billed using CPT code 58120 because the surgery was performed to obtain sufficient tissue for sampling.
Applicable Modifiers for CPT Code 58120
You may apply the following modifiers with CPT code 58120 according to the circumstances. However, ensure to check the payer-specific guidelines before applying these:
Modifier 51
If you are performing multiple related procedures during the same session, then you can append modifier 51 with CPT code 58120. However, you must list the procedure that has the highest relative value unit (RVU) first, without a modifier. Then add the second with a lower RVU with this modifier.
Modifier 54
It is used for “Surgical Care Only,” which, in medical billing, signifies that a physician conducted only the surgical procedure, without managing the pre-operative or post-operative care.
CPT Code 58120 – Billing & Reimbursement Guidelines
You must adhere to the following billing and reimbursement rules to prevent denials for CPT code 58120.
Understand CPT Code 58120 vs. 58100
The majority of CPT codes differ from one another based on minor variations. The slight variations cause medical billers considerable confusion. Specifically, CPT code 58120 is used for a dilation and curettage, which involves both cervical dilation and the removal of tissue from the uterine lining.
On the other hand, CPT code 58100 is for an endometrial biopsy without cervical dilation. The key distinction lies in whether or not the endometrial biopsy was performed with cervical dilation.
Include Supporting Documentation
Your documents must reflect the necessity of the procedure! The insurance payer requires appropriate diagnostic ICD-10 codes to understand the patient’s condition and the reason behind the rendered services. Furthermore, the following essential information is also needed for fair reimbursement.
- Record that a D&C was performed.
- Indicate that the procedure was non-obstetrical.
- Clearly state the reason for the D&C.
- Detail the sample obtained.
- Specify whether diagnostic or therapeutic.
Be Aware of the Global Surgery Days
The global surgery days for CPT code 58120 are 10 because it is a minor surgery. Therefore, you cannot separately bill pre- or post-surgical services 10 days after the procedure. The global payment for 58120 will include the reimbursement for all pre-operative, intra-operative, and post-operative services.
Follow Each Payer’s Rules
We cannot stress enough the importance of reviewing each payer’s policies before submitting your claims. Each payer has their distinct rules regarding the payment. Plus, their policies may vary on bundling, modifiers, or documentation. So, to avoid any confusion afterward, you must stay up to date with their policy changes.
Summary
Before we take leave, let’s quickly recap the information discussed in this blog. CPT code 58120 represents a non-obstetrical dilatation and curettage for diagnostic and/or therapeutic purposes. You may apply this code in various scenarios, including obtaining uterine tissue for uterine cancer diagnosis or to confirm or rule out polyps. Furthermore, you may append modifiers, like 51 or 54, depending on the situation.
Lastly, we emphasized the importance of attaching detailed documentation and taking payer-specific policies and global days into account.
However, if you are still struggling with coding or want to mitigate claim denials, we recommend outsourcing your billing to professional OBGYN billing services providers.
