Ob-Gyn Coding Alert

Question: When my physicians perform the Essure procedure for sterilization, they also administer a paracervical block. I use V25.2 for the Essure, but Medicaid is denying the paracervical block with V25.2. What diagnosis code should I use for the block?

North Carolina Subscriber

Answer: Because the patient does not appear to have a second condition that would warrant the paracervical block, the only diagnosis code that applies to this situation would be V07.8 (Other specified prophylactic measure) -- but your diagnosis may not be the real issue. Your carrier will likely deny your claim, no matter what ICD-9 code you use. Check its policy to see if it bundles anesthesia with the Essure procedure.

Check: You should also look at your CPT codes and modifiers. You should apply modifier 47 (Anesthesia by surgeon) to the Essure code (58565, Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants). Also, report 64435-51 (Injection, anesthetic agent; paracervical [uterine] nerve; Multiple procedures) as your second procedure.