58558 CPT Code Reimbursement Explained

CPT code 58558 is an important gynecological procedure code that is used for hysteroscopy with sampling or removal of tissue from the uterus. As a medical billing professional, it is key to understand proper billing and reimbursement for this CPT code.

Key Takeaways:

• CPT code 58558 is for hysteroscopy with sampling, polypectomy, with or without D&C
• Use 58558 when a biopsy, polyp removal, or D&C is performed during the hysteroscopy procedure
• 58558 is not to be used if only diagnostic hysteroscopy is performed
• Reimbursement rates vary based on location, payer contracts, and other factors
• Proper billing for 58558 requires documenting medical necessity and all procedures performed

What is Included in CPT Code 58558?

CPT code 58558 is defined as Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C. This code is used when a surgical hysteroscopy is performed and tissue sampling, polyp removal, or D&C is done during the same operative session.

Some key components of CPT 58558 include:

• Surgical hysteroscopy – This refers to the visualization of the uterine cavity using a hysteroscope that is inserted through the vagina and cervix.
• Sampling/biopsy – Taking a sample of tissue from the endometrium for pathology analysis.
• Polypectomy – Removal of uterine polyps identified during the hysteroscopy.
• D&C – Dilation and curettage, which is scraping tissue from the uterus.

When to Use 58558 vs Other Codes

It is important to understand when CPT code 58558 is appropriate vs. other hysteroscopy codes:

• Use 58558 when sampling, polypectomy, or D&C is performed along with the diagnostic hysteroscopy.
• Use 58555 for Hysteroscopy, diagnostic when no procedures are done other than visualizing the uterine cavity.
• Use 58561 for Hysteroscopy, surgical; with removal of leiomyomata if fibroid removal is performed.
• Use 58562 for Hysteroscopy, surgical; with endometrial ablation if ablation is performed without biopsy/polypectomy/D&C.

Reimbursement and Billing Considerations

Reimbursement for 58558 will vary based on factors like geographical location, individual payer fee schedules, and provider contracts. However, on average, Medicare reimbursement is approximately $600 for this CPT code.

When billing CPT 58558, it is important to document the medical necessity and report all procedures performed. Key documentation should include:

• Indications – Document the signs/symptoms leading to performing the hysteroscopy and any procedures.
• Visualization – Note the uterine anatomy, any abnormalities seen.
• Tissue sampling – Note sampling of endometrial tissue, number of samples obtained.
• Polypectomy – Describe any polyps removed, size, location.
• D&C – Note if D&C was performed.
• Specimens – Describe specimens obtained, sent to pathology.

By understanding proper use of CPT code 58558 and following accurate billing and documentation protocols, medical coders can ensure appropriate reimbursement for these key women’s health procedures.

Frequently Asked Questions

What is the difference between 58555 and 58558?

58555 is for diagnostic hysteroscopy only, while 58558 includes procedures like biopsy, polypectomy, D&C along with the hysteroscopy.

When do you use 58562 vs 58558?

58562 is specifically for hysteroscopy with endometrial ablation. 58558 is used if ablation is not performed but biopsy, polypectomy and/or D&C is done.

Can 58558 be billed if only a biopsy is taken?

Yes, 58558 can be billed for hysteroscopy with just biopsy sampling, even if polypectomy and D&C are not performed.

What documentation is needed for 58558?

Document indication, visualization, tissue sampling technique, specimens obtained, and any other procedures like polypectomy or D&C.

What affects 58558 reimbursement?

Reimbursement depends on factors like geographic location, payer fee schedules, provider contracts. Medicare reimbursement averages around $600.