Author Topic: 58563 billed with 58120  (Read 4321 times)

jwangelin

  • Newbie
  • *
  • Posts: 20
58563 billed with 58120
« on: November 16, 2010, 07:39:35 AM »
I work for an Ob-Gyn physician.  She performs ablations and at the same time does a D&C.  Can I bill 58563 along with 58120 and mod 51, or is 58120 considered part of 58563?

oneround

  • Full Member
  • ***
  • Posts: 227
Re: 58563 billed with 58120
« Reply #1 on: November 16, 2010, 10:40:08 AM »
How are they doing the ablation are they using Novasure?
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

jwangelin

  • Newbie
  • *
  • Posts: 20
Re: 58563 billed with 58120
« Reply #2 on: November 16, 2010, 02:46:51 PM »
Yes

oneround

  • Full Member
  • ***
  • Posts: 227
Re: 58563 billed with 58120
« Reply #3 on: November 16, 2010, 04:33:59 PM »
CPT/HCPCS to CCI Code Check


NOTE: Effective 1/1/09, the facility version of NCCI edits will include edits for the following categories of service: Anesthesia (00100-01999), E&M (92002-92014, 99201-99499), and MH (90804-90911). Prior to 2009, these code pairs were excluded from the facility edits.

Code / Description 
58563  HYSTEROSCOPY, ABLATION M  Rel Wt: 37.22   
 
 
No bundling issues exist 
58120  DILATION AND CURETTAGE M  Rel Wt: 20.05   
 
 
Code 58120 is a component of Column 1 code 58563 but a modifier is allowed in order to differentiate between the services provided.
 
 



 
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

jwangelin

  • Newbie
  • *
  • Posts: 20
Re: 58563 billed with 58120
« Reply #4 on: November 17, 2010, 12:40:15 PM »
So is 51 the appropriate mod, or is 59.

oneround

  • Full Member
  • ***
  • Posts: 227
Re: 58563 billed with 58120
« Reply #5 on: November 17, 2010, 05:02:46 PM »
 Had the D&C been performed for diagnostic purposes for a clearly separate indication, you could report 58120 separately with modifier 59 (distinct procedural services) appended to override the CCI edit otherwise the 58563 would cover it all
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare