Ob-Gyn Coding Alert

Question: For a Medicare patient, if my ob-gyn fits/inserts a pessary, I should report 57160 and the pessary code supply, right? But my ob-gyn also inserted an Estring^® vaginal ring during the same visit. Should I bill the Estring^® insert considering that the patient has Medicare? If so, how should I code this?

AAPC Forum Member

Answer: You should report 57170 (Diaphragm or cervical cap fitting with instructions) for the Estring^® ring and 57160 (Fitting and insertion of pessary or other intravaginal support device) for the mechanical ring. These two codes are not bundled by Medicare and are separately billable, but keep in mind Medicare Part B does not cover birth control which is what 57170 describes. Some Medicare Advantage programs may cover it, so be sure to check before billing. You can also report the appropriate evaluation and management (E/M) service with 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) appended if your ob-gyn performed a separately identifiable and significant E/M service during this encounter.