Can’t identify the root cause for repeated endometrial ablation denials? Maybe it is because you are not using the right code. Looking at the recent trends, there has been a significant decline in the annual number of endometrial ablations. However, endometrectomy remains a common treatment for heavy periods. In fact, healthcare providers still perform approximately 250,000 such procedures each year.
Hence, we know that endometrial ablation might still be a routine surgery in your practice. That’s why we want you to bill it accurately. However, for that, you must understand the ins and outs of CPT code 58563. Let’s start with a straightforward description before moving on to detailed application examples.
CPT Code 58563 – Description
So, what is the official description of this code? CPT code 58563 specifies a hysteroscopy with endometrial ablation. But what exactly are these procedures? A hysteroscopy is a minimally invasive procedure that healthcare providers, mainly OBGYNs, perform to view the inside of a patient’s uterus.
Meanwhile, endometrial ablation is performed to destroy the lining of the uterus. In simple words? Coders use the 58563 CPT code to report that a healthcare professional has completely destroyed a patient’s uterine lining via hysteroscopy.
Scenarios Where CPT Code 58563 is Applicable
The following examples will help you understand CPT code 58563 better:
Hysteroscopic Endometrial Ablation to Treat Menorrhagia
Heavy bleeding (menorrhagia) is a common menstrual disorder, affecting 27 to 54% of women who menstruate. In fact, it accounts for over 18% of all gynecology visits in the U.S. The primary treatment depends on the cause of the disorder. However, healthcare providers recommend endometrial ablation in some cases.
So, for this example, consider a 38-year-old pre-menopausal woman with menorrhagia. She arrives in the ER due to severe abdominal cramps and abnormal bleeding. The healthcare provider quickly attends to her, asking her a series of questions about her menstrual cycle and conducting several tests. He learns that her previous gynecologist recommended conventional medications to control heavy menstrual bleeding.
Depending on the test results, her age, and failed conventional treatment, the healthcare provider performs an endometrial ablation via hysteroscopy. He then uses CPT code 58563 to bill for this procedure.
Endometrial Ablation to Manage Uncontrolled Menstrual Bleeding
According to the Centers for Disease Control and Prevention (CDC), over 10 million American women suffer from heavy periods each year. While this condition is not an immediate risk, it usually disrupts the patients’ daily lives.
In this scenario, let’s suppose a 35-year-old obese woman arrives at a gynecology outpatient department. The reason? Uncontrolled heavy menstrual bleeding. After evaluating the patient and taking her history, the healthcare provider learns that her periods also involve passing large clots.
He conducts several tests and then performs hysteroscopic endometrial ablation to control this unusual bleeding. His billing team documents the procedure using CPT code 58563.
Hysteroscopic Endometrial Ablation to Stop Excessive Blood Loss
Heavy menstrual bleeding is often the leading cause of iron deficiency in women, eventually resulting in anemia. So, for the last scenario, let’s assume a 37-year-old woman arrives at her gynecologist’s clinic with several complaints, including persistent fatigue, dizziness, and headache.
The main cause of these symptoms? Heavy periods lasting more than 7 days in each cycle. Noticing the patient’s sickly pallor, the healthcare provider orders blood tests. After learning that the patient has anemia due to excessive blood loss and trying various treatments, the OBGYN eventually recommends endometrial ablation.
She performs the procedure via hysteroscopy to stop the patient’s heavy menstrual cycle and uses CPT code 58563 to report it.
Applicable Modifiers for CPT Code 58563
The following modifiers are commonly used with CPT code 58563:
Modifier 53
Did you abandon endometrial ablation after administering anesthesia? If you discontinued the procedure due to risks, like bleeding, infection, patient discomfort, or damage to nearby organs, you can use modifier 53 with CPT code 58563.
Modifier 59
Was the hysteroscopic endometrial ablation you performed distinct from other services? To communicate this information, append modifier 59 to CPT code 58563. This modifier will help you avoid a single payment for separately identifiable services performed on the same day.
CPT Code 58563 – Billing & Reimbursement Guidelines
Eliminate the root cause of your repeated denials by following our reimbursement guidelines for CPT code 58563:
Use CPT Code 58563 for Endometrial Ablation via Hysteroscopy
Remember that this code covers both hysteroscopy and endometrial ablation. Many providers fail to resolve their denied claims because they bill for these services separately. The main reason? Confusing bundling rules.
Keep one more thing in mind! Endometrial ablation is a minor surgery. Hence, the 58563 CPT code has a 0-day global period and does not include pre- or post-operative days.
Record Relevant Details About the Procedure
You must know by now how important documentation is for timely approvals. Therefore, you must justify the reason for performing an endometrial ablation. Keep missing important details? Here is what you should document in the patient’s record:
- Diagnosis (heavy menstrual bleeding)
- Previous treatment and response (medications or any other service)
- Current condition
- Approach (hysteroscopy)
- Method of ablation (radiofrequency, cryotherapy, or any other)
Verify Payer-Specific Requirements
Another common reimbursement tip that we always give is to verify each payer’s specific billing requirements. We know that this may sound repetitive, but it is the easiest way to avoid persistent denials and rework. Therefore, confirm the bundling rules and coverage policies of each insurer before filing a claim for CPT code 58563.
Final Word
Address the root cause of your persistent denials with our comprehensive guide! You should be aware by now that CPT code 58563 is a crucial hysteroscopic procedural code. It simply refers to endometrial ablation, that is, the destruction of the uterus lining to stop unusual bleeding. While it seems like straightforward code, professionals make mistakes due to bundling rules.To help you avoid common coding mistakes, we have covered all the key aspects of this code, starting from a straightforward description to billing guidelines. But if you would rather partner with an expert, consider a trusted biller who specializes in your field. Many billing companies, including MediBillMD, offer exceptional OBGYN billing services and can help you file accurate claims.
