Disclaimer: The information provided herein reflects Cook’s understanding of the procedure(s) and/or device(s) from sources that may include, but are not limited to, the CPT codingsystem; Medicare payment systems; commercially available coding guides; professional societies; and research conducted by independent coding and reimbursement consultants. This information should not be construed as authoritative. The entity billing Medicare and/or third party payers is solely responsible for the accuracy of the codes assigned to the services and items in the medical record. Cook does not, and should not, have access to medical records, and therefore cannot recommend codes for specific cases. When you are making coding decisions, we encourage you to seek input from the AMA, relevant medical societies, CMS, your local Medicare Administrative Contractor and other health plans to which you submit claims. Cook does not promote the off-label use of its devices.

‡ The Balloon Uterine Stent is not separately reportable outside the underlying procedure.

Hysteroscopy Procedures

2017 CODING AND REIMBURSEMENT GUIDE

Cook Medical manufactures medical devices that may be used in different hysteroscopic procedures. The table below identifies a number of Cook Medical devices and the procedures in which they are intended to be used. Without a patient’s actual medical record it is impossible to know exactly how a given device was used, or exactly what procedure was performed and, consequently, how the procedure should be coded. This table is not intended to suggest how any given procedure using one of these Cook Medical devices should be coded for billing purposes. If you have any questions, please contact our reimbursement team at 800.468.1379 or by e-mail at reimbursement@cookmedical.com.

CPT® Code Description

No

vy C

orn

ual

Can

nula

tion

Set

NC

ircle

® N

itino

l H

yste

rosc

op

ic

Poly

p S

nare

Hys

tero

sco

pic

Po

lyp

Sna

re

Cup

Bio

psy

Fo

rcep

s

Bal

loo

n U

teri

ne S

tent

Hys

tero

sco

pic

Myo

ma

Scre

w

Co

ok®

Syr

ing

e A

ssis

t Dev

ice

58340 Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography

(For radiological supervision and interpretation of saline infusion sonohysterography, use 76831)

(For radiological supervision and interpretation of hysterosalpingography, use 74740)

X ‡ X

58555 Hysteroscopy, diagnostic (separate procedure) ‡ X

58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C

X X X ‡ X

58559 . . . with lysis of intrauterine adhesions (any method) ‡ X

58560. . . with division or resection of intrauterine septum (any method) ‡ X

58561 . . . with removal of leiomyomata X ‡ X X

58562 . . . with removal of impacted foreign body ‡ X

58563 . . . with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation) ‡ X

58565 . . . with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants ‡ X

Payment

Ambulatory Surgery Center Outpatient Hospital Physician Services

CPT Code Description

Facility Payment (National Medicare

Avg)1 APC

Facility Payment (National Medicare

Avg)2

Fee When Service Is

Provided in the Hospital or ASC(National Medicare

Avg)3

Fee When Service Is Provided

in the Office(National Medicare

Avg)3

58340 Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography

Package service, no separate

payment made

Items and services packaged into

APC rate $59.58

58555 Hysteroscopy, diagnostic (separate procedure)

$1,065.30 5414 $2,084.59 $157.91 $272.75

58558 Hysteroscopy,surgical;with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C

$1,065.30 5414 $2,084.59 $241.17 $1,382.07

58559 Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)

$1,794.97 5415 $3,809.24 $ 297.16 N/A*

58560 Hysteroscopy, surgical; with division or resection of intrauterine septum (any method)

$1,794.97 5415 $3,809.24 $325.51 N/A*

58561 Hysteroscopy, surgical; with removal of leiomyomata

$1,794.97 5415 $3,809.24 $449.33 N/A*

58562 Hysteroscopy, surgical; with removal of impacted foreign body

$1,065.30 5414 $2,084.59 $238.30 $345.97

58563 Hysteroscopy, surgical; with endo-metrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)

$1,794.97 5415 $3,809.24 $280.65 $1,613.91

58565 Hysteroscopy, surgical; with bilateral fallopian tube cannula-tion to induce occlusion by place-ment of permanent implants

$1,794.97 5415 $3,809.24 $442.15 $1,907.84

¹ 2017 Medicare Ambulatory Surgery Center Fee Schedule ² 2017 Medicare Hospital Outpatient Prospective Payment System (OPPS) Fee Schedule ³ 2017 Medicare Physician Fee Schedule

* Medicare has not developed a rate for the in office setting because these procedures are typically performed in a hospital setting. Physicians should contact the Medicare contractor to determine if the service can be performed in office. If the contractor determines the service or procedure may be performed in office, the physician will receive Medicare’s physician fee schedule amount for procedures performed in the hospital/ASC.

CPT © 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

2017 physician fees for your local area can be found at the following CMS link:

https://www.cms.gov/apps/physician-fee-schedule/overview.aspx

or

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/

PhysicianFeeSched/index.html

Disclaimer: The information provided herein reflects Cook’s understanding of the procedure(s) and/or device(s) from sources that may include, but are not limited to, the CPT coding system; Medicare payment systems; commercially available coding guides; professional societies; and research conducted by independent coding and reimbursement consultants. This information should not be construed as authoritative. The entity billing Medicare and/or third party payers is solely responsible for the accuracy of the codes assigned to the services and items in the medical record. Cook does not, and should not, have access to medical records, and therefore cannot recommend codes for specific cases. When you are making coding decisions, we encourage you to seek input from the AMA, relevant medical societies, CMS, your local Medicare Administrative Contractor and other health plans to which you submit claims. Cook does not promote the off-label use of its devices.

$121.30

© COOK 2017 RG_RH_HPCRG_RE_201701