58559

⚕️CPT Code 58559 - Hysteroscopy, Surgical; With Removal of Leiomyomata

Quick Reference

Descriptor: Hysteroscopy, surgical; with removal of leiomyomata ¹ Global Period: 0 days (Endoscopy) ⁶² Assistant Surgeon: Payable with modifiers -80, -81, -82, -AS ⁵²
wRVU: 6.63 | Total RVU: 11.76 (Non-Facility) ¹⁵
NCCI Status: Bundles diagnostic hysteroscopy 58555 and biopsy 58558; modifier indicator “1” for some distinct procedures ⁷¹

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📋 Code Description & Clinical Context

58559 describes a surgical hysteroscopy performed to remove leiomyomata (uterine fibroids) from within the uterine cavity ¹. This procedure involves the insertion of a hysteroscope through the cervix into the uterus to visualize and resect submucosal fibroids using mechanical, electrosurgical, or laser techniques ⁴.

Key Clinical Indications:

• Abnormal uterine bleeding (AUB) caused by submucosal fibroids
• Infertility workup where intracavitary fibroids impede implantation
• Recurrent pregnancy loss associated with intracavitary lesions
• Symptomatic submucosal leiomyomata (pain, pressure, bleeding)

Submucosal Specificity

This code is specific to submucosal leiomyomata (those protruding into the endometrial cavity). Intramural or subserosal fibroids not entering the cavity are typically not accessible via hysteroscopy and may require laparoscopic or open myomectomy ⁹³.

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🌲 Code Hierarchy / Tree

Surgery (10000-69990)
└─ Female Genital System (55000-58999)
   └─ Corpus Uteri (58100-58299)
      └─ Hysteroscopy (58555-58579)
         ├─ 58555 Hysteroscopy, diagnostic (separate procedure)
         ├─ 58558 Hysteroscopy, sampling (biopsy)
         ├─ 58559 Hysteroscopy, surgical; with removal of leiomyomata ← THIS CODE
         ├─ 58561 Hysteroscopy, surgical; with removal of polyp(s)
         └─ 58563 Hysteroscopy, surgical; with lysis of intrauterine adhesions

Parent Category: Hysteroscopy (58555-58579) ²⁶
Related Approach: Laparoscopic myomectomy 58572 or Open myomectomy 58140 for non-submucosal fibroids

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💰 Reimbursement & Valuation

Component	Facility	Non-Facility	Notes
Work RVU	6.63	6.63	Physician effort component 15
Practice Expense RVU	3.85	4.50	Overhead/equipment (higher in office) 15
Malpractice RVU	0.63	0.63	Liability component 15
Total RVU	11.11	11.76	Base for payment calculation
Global Period	0 days	0 days	Endoscopy family; pre-op day only included 62 68

Assistant Surgeon Payable: Yes

• Report with modifiers: -80 (Assistant Surgeon), -81 (Minimum Assistant), -82 (Assistant when resident unavailable), or -AS (PA/NP/CNS assistant) ⁵²
• Medicare Status Indicator: “1” (Payment permitted for assistant at 80/85/50%)
• Reimbursement typically 16-25% of primary surgeon fee depending on payer policy

Medicare Payment Estimate: National average ~$420-$450 (Physician Fee), Facility fees separate ¹¹⁴

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🚫 Includes / Excludes & NCCI Guidance

✅ Includes

• Insertion of hysteroscope through cervix
• Distension of uterine cavity (fluid or CO2)
• Visualization of endometrial cavity
• Resection of submucosal leiomyomata (fibroids)
• Use of resectoscope, scissor, grasping forceps, or electrosurgical loop
• Control of bleeding at resection site

❌ Excludes / Bundled Per NCCI

• Diagnostic hysteroscopy 58555 (bundled into surgical hysteroscopy) ⁷¹
• Endometrial sampling/biopsy 58558 (bundled when performed same session) ⁷⁸
• Dilation and Curettage (D&C) 58120 (unless distinct separate indication/site)
• Hysteroscopy with polypectomy 58561 (if polyps are removed in addition to fibroids, check NCCI; often mutually exclusive or requires modifier)
• Laparoscopic or open myomectomy (different approach)

NCCI Edit Critical Note

58555 and 58558 are bundled into 58559 with a modifier indicator of “0” in many contexts, meaning they cannot be billed separately even with modifiers -74. However, if 58561 (polypectomy) is performed at a distinct site or session, modifier -59 or -XS may be applicable if the edit allows (Indicator “1”) ⁷¹.

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🏥 MS-DRG Assignment (Inpatient Facility)

While 58559 is predominantly an outpatient/ASC procedure, if performed in an inpatient setting:

Scenario	MS-DRG	Description
Primary procedure: Uterine & Adnexa for Non-Malignancy with MCC	742	Highest severity/complexity 92
Primary procedure: Uterine & Adnexa for Non-Malignancy with CC	743	Moderate complexity 92
Primary procedure: Uterine & Adnexa for Non-Malignancy without CC/MCC	744	Baseline complexity 92

Note:

Inpatient admission for simple hysteroscopic myomectomy is rare and may be subject to denial under Two-Midnight Rule unless significant comorbidities exist ⁹¹.

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🏷️ Common ICD-10-CM Diagnosis Codes

Primary Diagnosis Options

ICD-10-CM Code	Description	HCC Status*
D25.0	Submucous leiomyoma of uterus	❌ Not HCC
D25.1	Intramural leiomyoma of uterus	❌ Not HCC
D25.2	Subserous leiomyoma of uterus	❌ Not HCC
D25.9	Leiomyoma of uterus, unspecified	❌ Not HCC
N92.0	Excessive and frequent menstruation with regular cycle	❌ Not HCC
N92.1	Excessive and frequent menstruation with irregular cycle	❌ Not HCC
N93.8	Other specified abnormal uterine and vaginal bleeding	❌ Not HCC
N94.4	Primary dysmenorrhea	❌ Not HCC

• HCC Status: Hierarchical Condition Category mapping for Medicare Advantage risk adjustment. Leiomyoma codes (D25.x) are benign neoplasms and do not map to active HCC categories in current CMS-HCC models ^{101 114}. They do not contribute to risk adjustment scores.

Supporting/Comorbid Codes (Document When Applicable)

• Z87.410 Personal history of dysplasia of cervix (if relevant history)
• Z78.1 Physical restraint status (rare, specific contexts)
• D64.9 Anemia, unspecified (if bleeding caused anemia)
• E66.9 Obesity, unspecified (if impacting surgical risk)

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✏️ Modifiers Guidance

Modifier	Use Case for 58559	Payable?
-22	Increased Procedural Services: fibroids exceptionally large, numerous, or vascular requiring significant extra time	✅ If documentation supports & NCCI allows
-50	Bilateral Procedure: Not applicable (Uterus is a single midline organ)	❌ Do not use
-51	Multiple Procedures: when performed with other distinct procedures (e.g., laparoscopy)	✅ Subject to multiple procedure reduction
-53	Discontinued Procedure: terminated due to patient risk (e.g., fluid overload, perforation risk)	✅ With operative note detail
-59	Distinct Procedural Service: if performed with 58561 (polypectomy) at distinct site/session	⚠️ Verify NCCI edit indicator first
-73	Discontinued Out-Patient Hospital/ASC Procedure Prior to Anesthesia	✅ Facility use only
-74	Discontinued Out-Patient Hospital/ASC Procedure After Anesthesia	✅ Facility use only
-80 / -81 / -82 / -AS	Assistant Surgeon services	✅ Payable per Medicare policy 52

Modifier -50 Warning

Do not report modifier -50 with 58559. The uterus is not a paired organ. Reporting ⁵⁰ will likely result in denial ⁷⁷.

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📝 Coding Examples

✅ Example 1: Standalone Hysteroscopic Myomectomy

Scenario: 42 y/o F with heavy menstrual bleeding. Ultrasound shows 2cm submucosal fibroid. Patient undergoes hysteroscopy. Fibroid resected using electrosurgical loop. Hemostasis achieved.
Report:

• 58559 (Hysteroscopy, surgical; with removal of leiomyomata)
• D25.0 (Submucous leiomyoma of uterus)
• N92.0 (Excessive menstruation)
  Rationale: Procedure matches descriptor exactly. Diagnostic hysteroscopy is bundled ⁹⁷.

❌ Example 2: Billing Diagnostic Hysteroscopy Separately (Incorrect)

Scenario: Surgeon performs diagnostic hysteroscopy, identifies fibroid, then proceeds to resect it using same scope session.
Report: 58555 + 58559
Rationale: Incorrect. 58555 is bundled into 58559 when performed in the same session. Report only 58559 ⁷¹.

⚠️ Example 3: Fibroid and Polyp Removal (Modifier Consideration)

Scenario: Surgeon removes one submucosal fibroid and one endometrial polyp during same session.
Report:

• 58559 (Primary)
• 58561--59 (Polypectomy, distinct procedure)
• Diagnosis: D25.0 and N84.0 (Polyp of corpus uteri)
  Rationale: NCCI edits may bundle 58561 into 58559. If the polyp is distinct and work is separate, modifier -59 may be allowed (check current PTP edit indicator). Some payers prefer only the primary procedure ⁷⁸.

✅ Example 4: Assistant Surgeon Participation

Scenario: Complex case with multiple fibroids. Assistant surgeon manages hysteroscope camera and fluid management while primary surgeon operates resectoscope.
Report:

• Primary: 58559
• Assistant: 58559--80
• Diagnosis: D25.0
  Rationale: Assistant surgeon services are payable for 58559; document assistant’s specific contributions ⁵².

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🔍 Documentation Essentials for Support

To support 58559 and mitigate audit risk, operative documentation should include:

1. Indication: Reason for procedure (e.g., bleeding, infertility).
2. Findings: Specific description of leiomyomata (size, location, number, type—submucosal).
3. Technique: Method of removal (resectoscope, laser, mechanical).
4. Distension Media: Type and volume of fluid used (critical for safety monitoring).
5. Completion: Confirmation of complete resection and hemostasis.
6. Specimen: Confirmation that tissue was sent to pathology.

Fluid Management

Document fluid deficit carefully. Excessive fluid absorption can lead to complications (hyponatremia). Documentation of fluid balance supports medical necessity and safety monitoring.

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⚠️ Common Pitfalls & Audit Risks

Pitfall	Consequence	Prevention
Reporting 58555 with 58559	Claim denial (Bundled)	Do not bill diagnostic code when surgical procedure is completed 71
Using 58559 for polyp removal	Incorrect coding (Upcoding/Downcoding)	Use 58561 for polyps; 58559 is specific to leiomyomata 93
Using modifier -50	Denial (Invalid for midline organ)	Remove modifier -50 for uterine procedures 77
Insufficient pathology documentation	Query/Denial	Ensure operative note states tissue was sent for path 97
Billing as inpatient without justification	DRG Downgrade/Denial	Ensure admission meets Two-Midnight Rule or status guidelines 91

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🔗 Related Codes & Crosswalks

Code Type	Code	Relationship to 58559
CPT®	58555	Diagnostic hysteroscopy (bundled)
CPT®	58558	Endometrial sampling (bundled)
CPT®	58561	Hysteroscopy with polypectomy (distinct lesion)
CPT®	58572	Laparoscopic myomectomy (different approach)
CPT®	58140	Open myomectomy (different approach)
ICD-10-PCS	0UB98ZZ	Excision of uterine support, via natural or artificial opening endoscopic (inpatient procedure coding)
HCPCS	None directly	No specific HCPCS Level II code crosswalk

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¹ AMA CPT 2024 Professional Edition
⁴ ACOG Practice Bulletin on Leiomyomata
¹⁵ CMS Medicare Physician Fee Schedule 2024
²⁶ NIH VSAC CPT Hierarchy
⁵¹ PayerPrice Fee Schedule 2026
⁵² Medicare Claims Processing Manual Ch. 12
⁶² CMS Global Surgery Factsheet
⁶⁸ Noridian Medicare Local Coverage Determinations
⁷¹ CMS NCCI Policy Manual 2024
⁷⁴ AAPC NCCI Edit Resources
⁷⁷ Coding Mastery Modifier Guidelines
⁷⁸ AHA Coding Clinic for ICD-10-CM/PCS
⁹¹ CMS Two-Midnight Rule Guidance
⁹² CMS MS-DRG Manual v41.0
⁹³ AAGL Hysteroscopy Guidelines
⁹⁷ AAPC Coding Hysteroscopy Procedures
¹⁰¹ CMS-HCC Model V28 Documentation
¹¹⁴ Find-A-Code HCC Mapping Tool