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(2023) 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; the provider may or may not dilate. The provider then has a pathology lab examine all the collected samples.

Description Of CPT Code 58558

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

For example, a 58555 (diagnostic hysteroscopy) is incorporated into 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 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 scope cost, fluid management system, polyp-resecting disposable devices and tubing, fluids and drapes, and gloves.

They also cover costs such as nurse time and supplies, 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 hysteroscopy. 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).

The RUC committee (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).

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

As Congress requires, 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

Billing Guidelines

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

Regarding 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 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 damage 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).

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 are 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.

Reimbursement

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

They provide a list of ASC procedures each year to track which procedures are covered by Medicare.

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 depends on the hospital’s outpatient rate.

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 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.

Billing 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 and remove the lines. 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.

Include the cost of the hysteroscope’s special equipment in your insurance statement.

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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