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Posted By Mary Peabody on 04-08-2020, 12:23:53 in Ob-Gyn
Hello Melanie,
Would you code this Manual Uterine Aspiration with an unlisted CPT 59899? She is PPD day #9 with postpartum bleeding. A D & C (59160) was performed postpartum on day 5, and now a Manual Uterine Aspiration performed on day 9
Procedure: Manual Uterine Aspiration
Indications: 36 y.o. who is now PPD#9 s/p uncomplicated NSVD2 presenting with heavy vaginal bleeding and on ultrasound found to have heterogeneous material in uterus.
Description of Procedure: She was placed in the dorsal lithotomy position. A Grave's speculum was inserted and the cervix was visualized and prepped in the usual sterile fashion with betadine. 2 mL of 1% lidocaine was injected into the cervix at the 12:00 position. A tenaculum was applied to the cervix at 12:00. 5 mL of 1% lidocaine was injected paracervically at 4 and 8 respectively, for a total of 10 mL. A 9mm flexible cannula was attached to the manual uterine aspirator and the cannula was then passed easily through the cervix under ultrasound guidance. The suction was applied and the cannula was passed through the uterus with multiple passes with significant amount of clot and blood. On ultrasound, reaccumulation of blood was seen in lower uterine segment. The patient received IM methergine 200mcg x1 during procedure and 5 units of vasopressin in 5mL of 1% lidocaine injected paracervically. The cannula was passed again to evacuate clots until gritty texture was appreciated. On ultrasound again reaccumulation of clot was seen thus decision was made to place an intrauterine foley balloon. The foley balloon was placed and filled with 40cc of saline. On ultrasound foley balloon appeared to be placed in the fundus with evidence of tamponade and no bleeding was noted around the os. The tissue obtained was retained for pathology. All instruments were removed from the vagina. The patient tolerated the procedure well with no apparent complications.
Comments (1)
Posted By Melanie Witt on 04-08-2020, 16:01:30
I think you are going to have to go with unlisted, especially as he also applied the balloon for bleeding control. The work would be very similar to that for 59841 in my opinion (physician work RVU is 5.65 versus 2.76 work RVUs for code 59160). You can also bill for ultrasound guidance with 76998.
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