Report 58999 for Endometrial Hyperplasia Treatment

Treatment of endometrial hyperplasia with the insertion of a hormone-containing intrauterine device (IUD) is an accepted method to manage endometrial hyperplasia for patients with abnormal uterine bleeding who are unable to tolerate, or at high risk for complications of, oral megestrol, states Palmetto GBA in its February 2012 Medicare Advisory.
The jurisdiction 1 Medicare administrative contractor (J1 MAC) says it will reimburse IUD insertion services for patients who meet these criteria effective for dates of service on or after Feb. 1, 2012.
For proper reimbursement, do not report CPT® code 58300 Insertion of intrauterine device (IUD) for endometrial hyperplasia treatment with an IUD for a Medicare patient. Medicare does not allow payment for contraceptive devices or medication, and the claim will be auto-denied.
Palmetto advises providers to, instead, bill the following information to avoid unnecessary claim denials:

  • CPT® code 58999 Unlisted procedure, female genital system
  • ICD-9 codes 621.30-621.34
  • Enter “hormone IUD” in the comment/narrative field

Read the Medicare Advisory report for other important coding information pertaining to fee-for-service providers who submit Medicare Part B claims to Palmetto GBA.
JF MAC Noridian Administrative Services recently updated its IUD (Hormone-Eluting) for Endometrial Hyperplasia local coverage determination (LCD), as well, to include coverage for treatment of endometrial hyperplasia with the insertion of a hormone-containing IUD. Guidance is the same with one exception: In item 19 of the CMS-1500 form or the electronic equivalent, enter “hormone IUD for endometrial hyperplasia.”

Medical coding books

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2 Responses to “Report 58999 for Endometrial Hyperplasia Treatment”

  1. sheri says:

    Is the devise also covered or just the procedure?

  2. Emilie Green says:

    The Mirena IUD is also a recognized and effective treatment for early stage endometrial cancer.
    Medicare will reject charges for insertion, the device and the removal, because it is typically submitted as a pregnancy prevention device.
    What codes should be used to have the procedures and device covered in this instance? This treatment is used both for younger women who wish to preserve fertility and avoid a radical hysterectomy, as well as, older women who are poor surgical candidates.