58563 billed with 58120

[jwangelin]

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]

How are they doing the ablation are they using Novasure?

[jwangelin]

Yes

[oneround]

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.
 
 



 

[jwangelin]

So is 51 the appropriate mod, or is 59.

[oneround]

 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

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