CODES.AND.STUFF

When D&C and hysteroscopy has been performed both procedures must be coded (as in point iv, indicated below).

The Coding Review Panel has received documentation from a Consultant Obstetrician and Gynaecologist which describes circumstances where the primary investigation is hysteroscopy with a directed biopsy. The diagnostic curettage is performed in the hope of possible therapeutic gain and also to ensure an adequate curettage.

The general tenet of OPCS-4 is the separate diagnostic and therapeutic interventions. However the documentation indicates that D&C can frequently be a mixture of both. It is, therefore, justifiable to introduce the code Q18.8 Other specified diagnostic endoscopic examination of uterus, as a separate code for combined diagnostic procedures and D&C and hysteroscopy. This does not contradict the intention of OPCS-4 in this field, as Q18.1 Diagnostic endoscopic examination of uterus and biopsy of lesion of uterus actually combines diagnostic examination with a biopsy of the uterus.

This allows for a number of combinations coded in the following ways:

i)    Diagnostic D&C

Q10.8 Other specified curettage of uterus

ii)    Therapeutic D&C (on its own)

Q10.3 Dilation of cervix uteri and curettage of uterus NEC

iii)    Diagnostic D&C and diagnostic hysteroscopy

Q18.8 Other specified diagnostic endoscopic examination of uterus

iv)    Therapeutic D&C and diagnostic hysteroscopy

Q10.3 Dilation of cervix uteri and curettage of uterus NEC

Q18.9 Unspecified diagnostic endoscopic examination of uterus (included hysteroscopy nec)

v)    Hysteroscopy only

Q18.9 Unspecified diagnostic endoscopic examination of uterus

vi)    D&C unspecified

Q10.3 Dilation of cervix uteri and curettage of uterus NEC

vii)    D&C NEC plus hysteroscopy NEC

Q18.9 Unspecified diagnostic endoscopic examination of uterus

Update history

12/2011: The guidance originally published in 01/1995 and the update published in 07/1996 have been compiled to form a single piece of guidance to avoid confusion.

07/1996: Further examples have been added to support the principles that were introduced in 01/1995.

Date first published: 01/1995 (Issue 18)

Coding Clinic, NHS Classifications Service

www.connectingforhealth.nhs.uk/codingclinic

Tags: curettage, D&C, dilation, gynaecology, hysteroscopy