Unsuccessful Pessary Fittings? Do This
Question: We’re having a discussion in my office about billing for unsuccessful pessary fittings, and opinions differ. If the fitting is performed, trialing one or more pessary sizes/types, but the final insertion is not done, should a modifier be appended to 57160? We are considering modifier 53 (Discontinued procedure) because patient decided to stop the trial and/or the procedure wasn’t completed. There was no insertion. We’re also considering modifier 52 (Reduced services) because final pessary insertion was not done. Should we report 57160 without a modifier because the fitting was performed? The procedure was considered unsuccessful, not reduced or discontinued. Georgia Subscriber Answer: Per the vignette submitted with this code to CPT®, the work would be as follows: “Insert the fitting pessary into the vagina. Assess the prolapse reduction. If inadequate reduction is achieved or the device is immediately painful, remove the device and select and place an alternative pessary model. Provocative maneuvers are performed while in the dorsal lithotomy position with direct physician observation after the initial evaluation for reduction and pain. Again, assessment is made of prolapse reduction. When complete reduction has been achieved, query patient regarding device comfort. If not uncomfortable, instruct the patient to sit, stand, walk, and perform provocative maneuvers in a standing position to assess device comfort and efficacy. Then re-examine the patient in the dorsal lithotomy position. If the patient experiences extrusion of the device, significant movement of the device, or pain, restart the fitting trial with a new fitting pessary style or size. Continue this process until an appropriate pessary is identified that effectively supports the prolapse and is not uncomfortable. Instruct the patient in the insertion and care of the pessary. If she has no physical limitations that prevent self-care, ask her to demonstrate removal and insertion of the pessary. Vaginal examination is repeated at that time to confirm patient has achieved proper placement without vaginal trauma.” If your ob-gyn performs less than this, and it appears they did, modifier 52 would be appropriate to add to 57160 (Fitting and insertion of pessary or other intravaginal support device). Suzanne Burmeister, BA, MPhil, Medical Writer and Editor
