cpt code 58558

(2022) CPT Code 58558 – Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 58558 is used for biopsies of the uterine lining or removing polyps (or both). This can be done using a hysteroscope and the provider may or may not dilate. The provider then has a pathology lab examine all of the samples they have collected.

CPT Code 58558 Description

Eight codes are used in hysteroscopy. The base code of each family is often included in any subsequent family codes.

For example, a 58555 (diagnostic hysteroscopy) is incorporated in a 58558 (hysteroscopic polypectomy).

Every year, the National Correct Coding Initiative (NCCI) discloses the details of which codes may and cannot be reported together (NCCI or CCI edits).

Many of these surgeries need a paracervical block since the anesthetic delivered by the surgeon is not billable to CMS (64435).

Five of the codes are graded when hysteroscopy is performed in an office rather than an institution.

For procedures conducted in a facility, the additional RVUs cover the costs that otherwise would have been paid by a physician’s office.

For example, hysteroscopic codes include the cost of the scope, fluid management system, polyp-resecting disposable devices and tubing, fluids and drapes, and gloves.

They also cover costs such as nurse time and supplies and the cost of the bed in the room and the exam table lamp.

As a provider, you are responsible for the consenting, examination, and documentation on the day of the procedure; you are also responsible for talking with the patient and their family.

The hysteroscope is inserted into the vaginal canal and the cervix via the cervix’s opening.

The treatment with laparoscopy may help identify or treat a problem to reach the uterine chamber, and abnormal uterine bleeding is a common reason for diagnosis.

To document this, use the CPT code 58558. Diagnosis hysteroscopy (separate procedure). A surgical procedure may be necessary during a diagnostic process.

In this case, just the surgical hysteroscopic code would be recorded.

Remember that diagnostic hysteroscopy is part of surgical laparoscopy/hysteroscopy; therefore, don’t record it separately.

Use 58558 as the CPT code for hysteroscope. An endometrial sample (biopsy) with or without a D&C may be taken during hysteroscopy surgically. 

Hysteroscopy may diagnose and treat various conditions.

Coding and billing must be done correctly for these procedures to proceed.

The correct price should encourage appropriate use in the right conditions while discouraging abuse or overuse.

AMA’s Correct Procedural Terminology (CPT) committee determines and documents the procedures to be followed (AMA).

RUC committee (also known as AMA/Specialty Society Relative Value Scale – RVC Update Committee) assesses the resources required for these operations.

It provides value to the Centers for Medicare and Medicaid Services (CMS).

It is up to CMS, on the other hand, to make the final decision on the matter.

As required by Congress, all CPT codes must be assigned a value based on the procedure’s length and severity.

58558 cpt code
CPT code 58558 Ambulatory procedures other

CPT Code 58558 Billing Guidelines

Physicians’ services are paid for using CPT codes according to a fee schedule.

When it comes to the Medicare Physician Fee Schedule, CPT codes serve as Relative Value Units (RVUs), indicating the amount of physician time, resources, and expertise necessary to provide services to patients.

Depending on the service is provided within a medical institution), the cost of equipment, personnel, supplies, and other expenses is included.

One of the CPT codes, 58558, may be found here. This procedure reports an IUD damaged and removes the impacted foreign body.

Providers should double-check with their insurance companies.

The practice expense includes all non-physician activities (clinical/administrative) and physical necessities (office/equipment/supplies) for the practice.

Consequently, since the patient only has to check in once, wear one gown, sit at one table, and so on, the RVUs for the office visit is reduced when an E&M CPT Code is billed on the same day as an office hysteroscopy surgery.

Because no work is repeated when performed on separate days, the total price is applied to both the E&M code and the procedure code.

Modifiers

A modifier should never be used only to increase reimbursement or obtain payment for an otherwise unbundled procedure.

On the other hand, modifiers might be problematic. Providers often misuse them, causing claim denials.

It may be necessary for a physician in certain situations to indicate that a treatment or service was not connected to or influenced by any other medicine or service on the same day.

Procedures and services that aren’t generally reported together but are appropriate in the specific scenario are referred to as 59 modifiers.

There are different reasons why a physician might not see the same patient or perform the same procedure on the same day, including a different patient and a different approach.

Modifier 59 should only be used when no other, well-established modifier is better appropriate.

As long as alternative descriptive modifiers aren’t accessible, Modifier 59 should be utilized.

Noun modifiers like the 59 are notoriously difficult for people to grasp. The most common use is to demonstrate that two or more surgeries were performed simultaneously, although at different sites on the body.

Another organ system, an additional incision or excision site, a distinct lesion, or an injury (or area of injury in extensive injuries) also used these modifiers.

Unfortunately, it’s often used to prevent services from being bundled or integrated under the same claim.

As long as you’re not trying to go past an insurance carrier’s edit system, it would help if you never utilized it.

The 59 modifications should be replaced with a modifier that adequately describes billed services.

The 59 modifiers should be used if no other, a more appropriate modifier is available to explain the link between two procedure codes.

The patient’s medical file should be documented proof when using the 59 modifiers for a different and distinct service.

A review of the patient’s medical records may be before it reimburses the total amount for the new CPT code.

It’s important to note that the 59 modifier does not require the use of a unique diagnostic code for each invoicing service.

Consequently, the 59 modifiers cannot be used if diagnostic codes are used for each service separately.

For CPT CODE 58558, 59 modifiers are used.

Reimbursement

An ASC is a surgical institution that is financially and administratively independent. In an ASC, Medicare limits the intricacy of surgical procedures.

To track which procedures are covered by Medicare, they provide a list of ASC procedures each year.

Outpatient hospital treatments and physician office-based procedures are the inspiration for the future payment system for ASCs.

Each CPT code for an ASC-covered procedure is assigned a relative weight and a flat payment amount, then changed for the ASC context.

There is a 50 percent discount if the code is submitted with another higher-weighted process, but a 100 percent discount if the code is filed as a single procedure or as the highest-weighted operation when the Multiple Process Discount is set to Yes (Y). 

There may be many procedures if different codes are entered for the same situation.

The payment indicator (PI) tells you how a legend is handled regarding payment.

For example, payment indication A2 refers to a surgical procedure for which the price is dependent on the outpatient rate at the hospital.

It is a non-office surgical therapy launched in CY 2008 or later, and payment is computed using OPPS’s relative payment weight.

Ambulatory Payment Classifications are the Medicare payment mechanism that will be utilized in the future to reward hospitals for outpatient services (APCs).

Each major operation’s CPT code 58558 is assigned to a single APC class based on clinical and resource commonalities.

Each APC is given a relative weight based on its costs relative to other processes.

The relative importance is converted to a set payment amount using a standard conversion factor.

CPT Code 58558 Examples

The following are examples of when CPT code 58558 may be used.

Example 1

A new patient has reported unusual bleeding. A hysteroscopy was determined to be medically required after a thorough examination.

On the same day, I also did the diagnostic hysteroscopy. What am I to do in the code?

A patient’s CPT code should accurately reflect the final diagnosis (fibroid, polyp, AUB, etc.).

To get the correct code, use 58558. In this case, the E&M code should be given a -59 modifier.

Example 2

A patient with a history was seen for IUD removal. On the test, there were no strings.

The IUD was not damaged when I used the hysteroscope to locate the lines and remove them. What am I to do in the code?

Using the laparoscopy, use the -59 modifier on the 58558 (Removal of IUD) code to reflect the additional time spent.

In your insurance statement, include the cost of the hysteroscope’s special equipment.

When an IUD is suspected, but the clinic doesn’t have access to an office hysteroscopy, code a 58555 like ultrasound and bill for it.

The 58562 number should be used if the IUD was inserted in the myometrium, and the papers must specify this.

Since she was an established patient who had just been in for the removal of her IUD, there was no E&M to code.

Billing for an ultrasound that indicated a regularly implanted IUD and a 58555, but did not evaluate if the IUD was impacted, would be incorrect since the procedure was only performed to detect the strings.

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