Coding for Contraceptive Procedures and Devices
- By Dawson Ballard
- In Coding
- May 1, 2023
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Protecting your practice from revenue loss is easy when you have all the facts.
In this everchanging world where more and more options are available for birth control, it’s important that we stay abreast of the latest coding. As you know, correct coding is the only way to ensure our providers receive proper reimbursement for their time and expenditures. To that end, let’s review procedure, supply, and diagnosis coding for some of the more common contraceptive services.
Vasectomy Coding
Vasectomies are common contraceptive procedures performed on males, usually in a urology office. According to the Mayo Clinic, vasectomies are “done by cutting and sealing the tubes that carry sperm. Vasectomy has a low risk of problems and can usually be performed in an outpatient setting under local anesthesia.”
Report the following code for a vasectomy performed in the outpatient setting:
55250 Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)
It’s important to remember that the code description includes the term “bilateral.” If the procedure is performed bilaterally, it would not be appropriate to append modifier 50 Bilateral procedure to the code. Also, the procedure includes postoperative semen examination(s), but you should be able to separately bill an office visit evaluation and management (E/M) or consultation for a pre-vasectomy visit, if performed.
Tubal Ligation Coding
Per the Mayo Clinic, “Tubal ligation — also known as having your tubes tied or tubal sterilization — is a type of permanent birth control. During tubal ligation, the fallopian tubes are cut, tied, or blocked to permanently prevent pregnancy.”
Tubal ligations are usually performed separately or immediately after or during the same hospital stay of labor and delivery. For the physician’s services, look to these tubal ligation codes and make your selection based on the procedure performed:
58600 Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral
58605 Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure)
+58611 Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery (not a separate procedure) (List separately in addition to code for primary procedure)
58615 Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach
When a physician performs a tubal immediately following a typical vaginal delivery, report the appropriate tubal with modifier 59 Distinct procedural service in conjunction with the delivery package code. If the tubal occurs during the hospital stay for the delivery, but not on the same day, append the appropriate tubal code with modifier 79 Unrelated procedure or service….
IUD Insertion Coding
Intrauterine devices (IUDs) can be used as a non-surgical form of birth control. They range from hormonal (Mirena®, Kyleena®, Skyla®, and LILETTA®) to copper (Paragard®).
The hormonal devices are a T-shaped plastic frame that is inserted into the uterus, where it releases the hormone progestin. To prevent pregnancy, progestin:
- Thickens mucus in the cervix to stop sperm from reaching or fertilizing an egg; and
- Thins the lining of the uterus and partially suppresses ovulation.
Mirena® prevents pregnancy for up to 7 years after insertion. Kyleena® has a 5-year duration. Skyla® has a 3-year duration, and LILETTA® has a 6-year duration.
Paragard® is sometimes referred to as a nonhormonal IUD option. The Paragard® device is a T-shaped plastic frame that’s inserted into the uterus. Copper wire coiled around the device produces an inflammatory reaction that is toxic to sperm and eggs, preventing pregnancy. Paragard® is the only copper IUD available in the United States. It can prevent pregnancy for up to 10 years after insertion.
There are two CPT® codes for IUDs: One is for insertion and one is used specifically for removal:
58300 Insertion of intrauterine device (IUD)
58301 Removal of intrauterine device (IUD)
These codes only cover the procedure itself. Report the actual device separately using the appropriate HCPCS Level II J code:
J7296 Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg
J7297 Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg
J7298 Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg
J7300 Intrauterine copper contraceptive
J7301 Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg
If an IUD is removed and a new one inserted in the same encounter, append modifier 51 Multiple procedures to the claim.
If removal or insertion of an IUD is discontinued mid-procedure, append modifier 53 Discontinued procedure. If the discontinued IUD procedure occurs in an ambulatory surgery center (ASC) setting, append modifier 73 Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure prior to the administration of anesthesia or 74 Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia, as appropriate, instead of modifier 53.
Etonogestrel Implant Coding
Etonogestrel is a form of birth control that contains a hormone in a flexible plastic rod about the size of a matchstick that is inserted just beneath the skin of the upper arm. The hormone stops the release of an egg from the ovary and mucus in the cervix thickens to help prevent sperm from reaching the egg. It’s effective for about 3 years.
The CPT® code set includes three specific codes for reporting etonogestrel implantation, removal, or removal with reimplantation:
11981 Insertion, drug-delivery implant (ie, bioresorbable, biodegradable, non-biodegradable)
11982 Removal, non-biodegradable drug delivery implant
11983 Removal with reinsertion, non-biodegradable drug delivery implant
As with IUD procedures, codes 11981-11983 are reported for the procedure only. You will also report the etonogestrel implant device. The correct HCPCS Level II code is:
J7307 Etonogestrel (contraceptive) implant system, including implant and supplies
Coding for E/M With Contraceptive Services
Most E/M services performed during the same encounter as vasectomies, tubal ligations, IUD insertions/removals, and etonogestrel insertion/removal/reinsertion are bundled into the procedure(s) and are not separately reportable. If, however, the physician performs a significant, separately identifiable E/M service during the encounter of one of these procedures, you may be able to separately bill the E/M service using modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service.
ICD-10-CM Codes for Contraceptive Services
Most of the ICD-10-CM codes for contraceptive services will be in category Z30 Encounter for contraceptive management.
Resources:
ACOG. (2021). Basic Contraceptive Implant Coding.
Mayo Clinic. (2018). Tubal ligation. www.mayoclinic.org/tests-procedures/tubal-ligation/about/pac-20388360
Mayo Clinic. (2019). Hormonal IUD (Mirena). www.mayoclinic.org/tests-procedures/mirena/about/pac-20391354
Mayo Clinic. (2019). Copper IUD (ParaGard). www.mayoclinic.org/tests-procedures/paragard/about/pac-20391270
Mayo Clinic. (2019). Vasectomy. www.mayoclinic.org/tests-procedures/vasectomy/about/pac-20384580
Mayo Clinic. (2018). Contraceptive implant. www.mayoclinic.org/tests-procedures/contraceptive-implant/about/pac-20393619
- Coding for Contraceptive Procedures and Devices - May 1, 2023
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