What Is the Correct CPT Code for Diagnostic Dilation and Curettage?

CPT codes are an integral part of the billing process used by insurance companies in healthcare.
CPT codes are an integral part of the billing process used by insurance companies in healthcare.

The Current Procedural Terminology (CPT) code for diagnostic dilation and curettage (D&C) is 58120. CPT codes are an integral part of the billing process used by insurance companies in healthcare. CPT codes are used to describe tests, surgeries, evaluations, and any other medical procedures performed by a healthcare provider on a patient. Every medical, diagnostic, or surgical procedure or service has an associated five-digit CPT code assigned to it. CPT codes are created, trademarked, and published by the American Medical Association (AMA). They have now become the standard for doctors, coders, patients, and insurance companies to label and identify medical services and procedures. Medical coding systems currently used in the United States are ICD-10-CM/PCS and Healthcare Common Procedure Coding System (HCPCS) (Level I CPT codes and Level II National Codes). HCPCS is used to report hospital outpatient procedures and physician services. CPT codes are of primary importance for a few different reasons that may include:

  • They are used by insurers to determine the amount of reimbursement a practitioner will receive under health insurance coverage (and ultimately how much of the bill the patient will be left responsible for).
  • They are used by insurers to determine whether a particular procedure is deemed to be wellness- or illness-related.
  • They can be used to diagnose medical billing errors.
  • They can be used to find out exactly what type of diagnostic, medical, or surgical work a physician has recommended.
  • Most of the medical claims are paid based on the CPT code submitted to the payer. The diagnosis code supports medical necessity and tells the payer why the service was performed.
  • These coding systems serve an important function for physician reimbursement, hospital payments, quality review, benchmarking measurement, and collection of general medical statistical data.

Each CPT code is five characters long and is based on three categories:

Category I: It describes most of the procedures performed by healthcare providers in inpatient and outpatient offices and hospitals that include:

  • Evaluation and Management: 99201-99499
  • Anesthesia: 00100-01999; 99100-99140
  • Surgery: 10021-69990
  • Radiology: 70010-79999
  • Pathology and Laboratory: 80047-89398
  • Medicine: 90281-99199; 99500-99607

Category II: This code set is used primarily for performance management. These codes are optional but may provide important information that can be used in performance management and future patient care. Example includes:

  • Patient Safety 6015F: Patient receiving or eligible to receive foods, fluids, or medication by mouth

Category III: These code sets are temporary codes that describe emerging and experimental technologies, services, and procedures. Once it is finalized, they are converted into Category I. Example includes:

  • The code for the fistulization of the sclera for glaucoma through the ciliary body is 0123T. In this case, the last letter of Category III codes is T. This is in the experimental stage.
CPT codes also have several modifiers that are two-digit additions to the CPT code that describe certain important facets of the procedure. CPT modifiers are relatively straightforward but are very important for coding accurately.

What is dilation and curettage?

Dilation and curettage (D&C) is a procedure to remove abnormal tissues from inside the womb. In this procedure, the doctor uses small instruments or medication to open (dilate) the cervix (the lower, narrow part of the womb). The doctor then uses a surgical instrument called a curette to remove the tissues from the womb. Curettes used in D&C may be sharp or may be used as suction. The doctor performs D&C to diagnose and treat certain uterine conditions such as

  • To know the cause of abnormal uterine bleeding.
  • To check why there is heavy bleeding after menopause.
  • To do a routine test for cervical cancer.
  • To diagnose endometrial hyperplasia (a precancerous condition in which the uterine lining becomes too thick).
  • To diagnose and treat uterine polyps and cancer.
  • To clear out tissues that remain in the uterus after a miscarriage or abortion to prevent infection or heavy bleeding.
  • To remove a molar pregnancy, in which a tumor forms instead of a normal pregnancy.
  • To treat excessive bleeding after delivery by clearing out any placenta that remains in the uterus.
D and C (Dilation and Curettage): https://www.webmd.com/women/guide/d-and-c-dilation-and-curettage#1

CPT® Codes: What Are They, Why Are They Necessary, and How Are They Developed? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865623/