We have created this web page to assist you in learning the process of scheduling surgery or office procedures, verifying benefits, and determining what your out of pocket expenses will be for your upcoming surgery or procedure.
Considering Surgery? Have it in Our Office!
We have increased our In Office Surgery Program!
Why?
* Lower costs for the patient
* Time savings for the patient and the Doctors * Reduced anesthesia
* Better patient tolerance
* Faster recovery time
* Procedure performed in the comfort of our office
Who?
* Ablations – Novasure
* Essure Birth Control
* LEEPS
* Minor procedures/biopsies requiring anesthesia
When?
Usually we perform these procedures one Friday each month, but can be done in the hospital other days
How?
Encompass Medical brings everything you and the doctor needs for an in office surgery experience. At a cost savings to you, their fee is only $325 (not covered by insurance), and not a percentage of your hospital fees (For example if you have a 90/10 plan, you are responsible for 10% of all fees, so if a hospital charges $10,000 for an ablation, your portion to the hospital alone would be $1000). See Insurance Information below for detailed insurance payment information.
Our doctors want you to be as comfortable as possible and use anesthesia for all ablations and Essure procedures
THINGS TO DO TO GET READY FOR SURGERY
1. Call your insurance company with the codes given below and ask the questions below to determine if your surgery/office procedure is covered and how much it will cost you. Pay close attention to your deductible! (We will call your insurance company also, but it is always good to have us both call)
2. Have all tests ordered by your doctor to ensure you are a candidate for surgery, and that insurance will approve your surgery/procedure. (Please see below for tests required)
3. Have your consult appointment with your doctor to discuss your test results, and all your treatment options, and finalize surgery plans. If you are not already on the surgery schedule, at this appointment time it is best to have the ideal days you are available to have your surgery.
4. Call our surgery scheduler at 817-424-3112 ext 8 to coordinate a surgery/procedure date. It takes 2-3 days to coordinate with hospital, anesthesia and assistant surgeons.
INSURANCE INFORMATION
If you are considering surgery, this section will give you the common procedures codes for surgeries we perform, so you can contact your insurance company to see if it is a covered benefit. You will need to ask your insurance company several questions:
Is the procedure code a covered benefit?
Is it covered at 100% or what is your percentage that you are required to pay. (this percentage will be paid to all involved in your care, for example if you owe 10%, then that is 10% to our office, 10% to the hospital, 10% to anesthesia, 10% to pathology). We can give you the allowable for our portion, you will need to contact the hospital and anesthesia office for information on their charges. (Baylor Grapevine 817-424-4545, Harris Methodist Southlake Center 817-748-8700, Pinnacle Anesthesia 972-233-1999)
Do you have a deductible to meet? What is it and how much of it has been met?
Do you have a facility co-pay?
If financially you are able to have the surgery, there are several clinical tests they need to be done in our office or ordered by our office to get your surgery approved. We will list those tests below. In general, you will need to have all required tests, and then a consult at our office with your doctor to discuss all the results, and develop your treatment plan. It is good to come to the consult appointment with some idea of dates you would like for your surgery. In general we use Tuesday’s and Friday’s as our blocked time for surgeries, although occasionally we can accommodate you on different days. We schedule hysterectomies and all in-patient surgeries on the 1st, 3rd and 5th Tuesday and Friday’s are for our outpatient procedures.
Procedure Codes for Surgery/Office Procedures & Tests Required for that Surgery
In Office or Hospital Endometrial Ablation (Novasure) CPT code 58563
* CBC, recent sonogram (within 6 months), recent pelvic exam, current pap smear, possible endometrial biopsy
In Office or Hospital Essure Tubal Ligation CPT code 58565
* CBC and pregnancy test
Total Laproscopic Hysterectomy (TLH) CPT code 58570
Total Abdominal Hysterectomy CPT code 58150
* CBC, sonogram, possible endometrial biopsy, recent pelvic exam, current pap smear
Laparoscopic Assisted Vaginal Hysterectomy (LAVH) CPT code 58550
* CBC, sonogram, possible endometrial biopsy, recent pelvic exam, current pap smear
Laparoscopic Supracervical Hysterectomy (LASH) CPT code 58544
* CBC, sonogram, possible endometrial biopsy, recent pelvic exam, current pap smear
Laparoscopic Bilateral Tubal Ligation (Tubes Tied) CPT code 58670 (Cowen) 58671 (Neal)
* CBC and pregnancy test
Removal of Ovarian Cyst (Laparascopy) 58661
* CBC
Hysteroscopy CPT code 58558
* CBC
Trans Obturator Sling (Bladder Repair) CPT code 57288
* CBC, urodynamic testing
Laser of Cervix CPT code 57513
* CBC the day of surgery
Hymenotomy CPT code 56700
* CBC the day of surgery
Hysterosalpingogram (HSG) CPT code 58340
Office Procedures
Colposcopy (Abnormal Pap Smear Evaluation) CPT code 57454
LEEP (Abnormal Pap Smear Treatment) CPT code 57522
Mirena IUD J7302 Insertion 58300 *For IUD device, deductibles typically apply
Paragard IUD J7300 Insertion 58300 *For IUD device, deductibles typically apply
Implanon J7307 Insertion 11981 or 11975 *For device, deductibles typically apply
RECOVERY
Abdominal Hysterectomy usually requires 2 nights in the hospital, and a 6 week recovery. You will not be allowed to drive for 2 weeks.
Vaginal Hysterectomy usually requires 1-2 nights in the hospital and a 4-6 week recovery. You will not be allowed to drive for 2 weeks.
Supracervical hysterectomy usually requires an overnight stay (23 hrs observation) and has a 2-4 week recovery. You will not be allowed to drive for 2 weeks.
Bladder surgery usually requires a 1 night stay in the hospital and a 2-3 week recovery.
Tubal ligations, hysteroscopy, laparoscopy and ablations are done on an outpatient basis, and have a 1-2 day recovery.
Surgery Checklist
1. Have initial appointment with your doctor
2. Call your insurance company and verify your benefits and your out of pocket expenses
3. Have all required clinical testing ordered
4. Have consult appointment to discuss all results of testing and establish treatment plan. At this time, please tell your doctor several different dates that you are available for surgery. He will then give your chart to our surgery scheduler.
5. Contact the surgery scheduler to confirm you are able to proceed with surgery. Kim can be reached at 817-424-3112 ext 8 or at www.surgery@grapevineob.com.
6. Give surgery coordinator 2-3 days to coordinate requested dates with hospital, assistant surgeons, and contact insurance company for verification and pre-certification.
Surgery coordinator will contact you with surgery time and date, location, and out of pocket expenses for proposed surgery. We send an email and/or a letter with all information.
Fees to our office are due 48 hours prior to your surgery time. You may pay in full with cash, check or credit card, or use our Online Payment Plan to satisfy your surgery charges to our office (www.grapevineob.com).
Pre Op Instructions – ALL SURGERIES
Nothing to eat or drink after midnight the night before your surgery No water, gum, candy or smoking on the morning of your surgery (you will be cancelled by anesthesia if you eat,drink, smoke or have candy the morning of your surgery) Report to the hospital at your designated time, 1 1/2 hours prior to your surgery time.
Avoid aspirin, and ibuprofen (Motrin) 2 weeks prior to your surgery