2021 BILLING AND CODING GUIDE GYNECOLOGY SURGERY

2023 Billing and Coding Guide

Gynecology surgery and Operative Hysteroscopy TruClear TM System

This guide is intended to aid providers in appropriate procedure coding for gynecological surgery and procedures associated with the operative hysteroscopy TruClearTM system. The document reflects applicable and commonly billed procedure codes as well as the unadjusted national Medicare average rates assigned to the CPT?1 code. This document is not all-inclusive, nor does it replace advice from your coding and compliance departments and/or CPT?1 coding manuals. CPT?1 code descriptions in this document have been shortened to the consumer-friendly version per the American Medical Association (AMA) guidelines.2 Note, CPT?1 consumer-friendly descriptors should not be used for clinical coding or documentation.3

HCPCS4 II Codes

Level II HCPCS4 codes are primarily used to report supplies, drugs and implants that are not reported by a CPT?1 code. HCPCS codes are reported by the physician, hospital or DME provider that purchased the item, device, or supply. Different payers have different payment methods for these items.

C-codes are a series of HCPCS codes that facilities reimbursed under the Medicare Outpatient Prospective Payment System (OPPS) are required to report for eligible items and services. Medicare assigns C codes to specific devices eligible for pass-through payment. Every year, in the OPPS rule, Medicare publishes a list of CPT?1 and HCPCS codes that are designated as device-intensive procedures. When reporting procedures on this list, facilities should capture both the CPT?1 code representing the procedure performed and the C-code representing the device used. Although Ccodes only affect Medicare outpatient reimbursement, facilities may also want to report C-codes on inpatient claims if the device is not used exclusively for inpatient procedures. Medicare tracks this information and uses it in its rate-setting process. Non-OPPS facilities may report C- codes at their discretion.

HCPCS II S-codes cannot be reported to Medicare. They are used only by non-Medicare payers, which cover and price them according to their own policies and provider contracts.

HCPCS4 code

Description

A4649 S2900

Surgical supply; miscellaneous

Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)

1

Procedure reimbursement

CPT?1 code

Description

Hysterectomy

58150

Removal of uterus and cervix through abdomen

Physician5

Hospital6 Outpatient

Ambulatory6 Surgery

Work RVU

Office Rate

Facility Rate

APC

SI

Rate

PI

Rate

17.31

NA

$1,029

NA

C

NA

NA

NA

58180

Removal of uterus through abdomen

16.60

NA

$974

NA

C

NA

NA

NA

58200

Removal of uterus through abdomen with partial removal of vagina

23.10

58210 58240 58260

Removal of uterus, cervix, and lymph nodes of pelvis with biopsy of lymph nodes of aorta

Removal of malignant uterus, cervix, lymph nodes, and bladder with transplant of ureters and bowel

Removal of uterus through vagina, 250.0 g or less

30.91 49.33 14.15

58262

Removal of uterus, tubes, and/or ovaries through vagina, 250.0 g or less

15.94

58263 58270

Removal of uterus, tubes, and/or ovaries with repair of herniated bowel through vagina, 250.0 g or less

Removal of uterus with repair of herniated bowel through vagina, 250.0 g or less

17.23 15.30

58275

Removal of uterus and vagina

17.03

58285

Removal of uterus, vagina, and pelvic lymph nodes through vagina

23.38

NA

$1,363

NA

C

NA

NA

NA

NA

$1,884

NA

C

NA

NA

NA

NA

$2,968

NA

C

NA

NA

NA

NA

$854

5415 J1 $4,635 G2 $2,008

NA

$942

5415 J1 $4,635 G2 $2,008

NA

$1,011 5415 J1 $4,635 NA

NA

NA

$911

5415 J1 $4,635 NA

NA

NA

$1,005

NA

C

NA

NA

NA

NA

$1,440

NA

C

NA

NA

NA

Please refer to page 5 for footnotes 2

Procedure reimbursement

Physician5

Hospital6 Outpatient

Ambulatory6 Surgery

CPT?1 code

Description

Hysterectomy, continued

Work RVU

58291

Removal of uterus, tubes, and/or ovaries through vagina, more than 250.0 g

22.06

Office rate

NA

Facility rate

APC SI

Rate

PI

$1,264

5415 J1 $4,635 NA

Rate NA

Partial removal of uterus with retention

58541

of cervix using an endoscope, 250.0 g or 12.29

NA

less

Partial removal of uterus, tubes, and/or

58542

ovaries with retention of cervix using an 14.16

NA

endoscope, 250.0 g or less

Partial removal of uterus, tubes, and/or

58544

ovaries with retention of cervix using an 15.60

NA

endoscope, more than 250.0 g

Removal of uterus, cervix, and lymph

58548

nodes of pelvis with biopsy of aortic

31.63

NA

lymph node using an endoscope

58550

Removal of uterus through vagina using an endoscope, 250.0 g or less

15.10

NA

Removal of uterus, tubes, and/or ovaries

58552

through vagina using an endoscope,

16.91

NA

250.0 g or less

Removal of uterus, tubes, and/or ovaries

58554

through vagina using an endoscope,

23.11

NA

more than 250.0 g

Removal of uterus, tubes, and/or ovaries

58571

through abdomen using an endoscope, 15.00

NA

250.0 g or less

58572

Removal of uterus through abdomen using an endoscope, more than 250.0 g

17.71

NA

Removal of uterus, tubes, and/or ovaries

58573

through abdomen using an endoscope, 20.79

NA

more than 250.0 g

Please refer to page 5 for footnotes

$742

5361 J1 $5,212? G2

$2,498

$845

5362 J1 $9,087 G2

$4,280

$923

5362 J1 $9,087 G2

$4,280

$1,905

NA

C NA

NA

NA

$896

5361 J1 $5,212 A2

$2,498

$997

5362 J1 $9,087 G2

$4,280

$1,322

5362 J1 $9,087 G2

$4,280

$922

5362 J1 $9,087 G2

$4,280

$1,054

5362 J1 $9,087 G2

$4,280

$1,234

5362 J1 $9,087 G2

$4,280

3

Procedure reimbursement

CPT?1 code

Description

Myomectomy

58545

Removal of growth of uterus using an endoscope, 250.0 g or less

Operative hysteroscopy TruClearTM system

58555

Diagnostic exam of uterus using an endoscope

Work RVU

15.55

2.65

Physician5

Office rate

Facility rate

Hospital6 Outpatient

APC SI

Rate

Ambulatory6 Surgery

PI

Rate

NA

$916

5361 J1

$5,212 A2

$2,498

$372

$153

5414 J1

$2,827 A2

$1,438

58558

Biopsy of lining of uterus and/or removal of polyp using an endoscope

4.17

$1,372

$233

5414 J1

$2,827 A2

$1,438

58561

Removal of growth of muscle of uterus using an endoscope

6.60

NA

$361

5415 J1

$4,635 A2

$2,008

59812

Treatment of miscarriage

59820

Treatment of miscarriage during first trimester

Oophorectomy

58940

Removal of ovaries

4.40 4.84

8.22

$372 $451

NA

$314 $395

$567

5414 J1

$2,827 A2

$1,438

5414 J1

$2,827 A2

$1,438

NA

C

NA

NA

NA

58943

Removal of ovaries for ovarian cancer

19.52

NA

Removal of lining of abdomen, uterus,

58953

ovaries, and fallopian tubes with extensive 34.13

NA

reduction of growth

$1,188

NA

C

NA

NA

NA

$2,026

NA

C

NA

NA

NA

Please refer to page 5 for footnotes 4

Procedure reimbursement

CPT?1 code

Description

Work RVU

Oophorectomy, continued

58954

Removal of lining of abdomen, uterus, ovaries, fallopian tubes, and lymph nodes 37.13 of pelvis and aorta for reduction of growth

58956

Removal of lining of abdomen, uterus, ovaries, and fallopian tubes

22.80

Tubal ligation

58605

Tying or incision of fallopian tubes during same hospitalization

5.28

58611

Tying or incision of fallopian tubes during cesarean delivery or other abdominal surgery

1.45

58615

Tying of fallopian tubes by device through vagina

3.94

58670

Destruction of fallopian tubes using an endoscope

5.91

58671

Blockage of uterine tubes by device using an endoscope

5.91

Physician5

Office rate

Facility rate

Hospital6 Outpatient

APC SI

Rate

Ambulatory6 Surgery

PI

Rate

NA

$2,190

NA

C

NA

NA

NA

NA

$1,378

NA

C

NA

NA

NA

NA

$344

NA

C

NA

NA

NA

NA

$77

NA

C

NA

NA

NA

NA

$259

5414 J1

$2,827 G2

$1,438

NA

$379

5361 J1

$5,212 A2

$2,498

NA

$379

5361 J1

$5,212 A2

$2,498

Footnotes

NA

Indicates that there is no established Medicare allowable in this site of care

SI

Indicates Status Indicator

PI

Indicates Payment Indicator

+

Add-on codes are always listed in addition to the primary procedure code

Comprehensive APCs (C-APCs)

?

Device intensive

?

Packaged Payment

RVU

Indicates Relative Value Unit

5

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