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Posted By Mary Peabody on 11-18-2019, 19:54:07 in Ob-Gyn
Hi Melanie Witt,

When billing myomectomy, CPT 58146 or 58546, if the myomas are not intramural but the weight is greater than 250 grams, can you still report 58146 or 58546? If the myomas were a combination of intramural, submucous, subserosa and total over 5 or more, can you report 58146 or 58456.

Thank you for your assistance.

Comments (3)
Posted By Melanie Witt on 12-01-2019, 12:46:54
You must have a confirmed Dx of an intramural fibroid to report 58146. A fibroid on the lower uterine segment does not tell us this. I would consult with your provider. A fibroid is only defined as intramural if it was mainly within the myometrium and did not impinge into the endometrial .
Posted By Mary Peabody on 11-19-2019, 18:45:12
Hello Melanie,

An abdominal myomectomy was performed on this patient and the path indicates that the fibroid weight was 470 gram. It was a 12 cm lower uterine segment fibroid.

Would this myomectomy be reported with CPT 58140 even if the weight is 470 grams?

The case is received fresh in a single part labeled with the patient's
name, medical record number, and "fibroid" and consists of a single firm
and oval pink red mass (470 gm and 12 x 11 x 7 cm).  The mass is well
circumscribed, dense, rubbery, firm, and has a whorled fibrous texture
without hemorrhage, necrosis or cysts.  No myometrium is identified.
Representative sections are submitted in cassettes A1 to A3.
Posted By Melanie Witt on 11-19-2019, 17:38:18
To qualify for 58146 or 58546 there must be 5 or more intramural fibroids or the total weight of 1-4 intramural fibroids is more than 250 g. Removal of surface myomas is not dependent on weight or number, but approach. You cannot combine the weight or number of fibroid types to bill 58146 or 58546
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