Check out the new diagnosis codes you'll start using this October. When an ob-gyn attempts to place an intrauterine contraceptive device (IUD) and is unsuccessful, you're often the one left with a quandary. What modifier should you include? The answer may depend on whose advice your payer follows. Our experts break down this real-life IUD scenario. First, Read This Procedure Note Although IUD insertion and replacement situations may seem simple coding-wise, an attempted and unsuccessful insertion is not so easy. Read the following procedure note. Procedure: A second attempt was made under ultrasound. We opened a second IUD and using ultrasound guidance attempted to place the IUD. It appeared that a false tract had been formed with the sound into the posterior uterus, but had not perforated the uterus itself. I was unable to get the IUD to go around into the remarkably anteflexed uterus despite multiple attempts and manipulation of the cervix itself. It became very uncomfortable for Ms. S, and she asked that I stop. I stopped attempting to place the second IUD. She has decided she wants to use Mircette birth control. A prescription was called in for this. Again, we attempted IUD placement and were unable to do it because of I think a false tract. I offered to place the second one at a later date, but she is not interested. We did use two IUDs today to attempt placement. The answer depends on whose advice your payer follows. Option 1: Opponents of this method point out that CPT's definition of modifier 53 states, "due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued." CPT's definition indicates that the physician must also have performed the surgical prep and anesthesia induction prior to discontinuing the procedure. Note that not every patient requires a local anesthetic for the IUD insertion. Also, CPT Assistant December 1996 explains you should use modifier 53 when a patient experiences an unexpected response or life-threatening condition that causes the procedure to be terminated (such as the patient fainting or developing an arrhythmia). In other words, you shouldn't append modifier 53 to report elective cancellation. Payment reduction Option 2: Payment reduction: Bottom line: Strike Out Visit, Supply Codes Here's what you should not include on your claim. The patient presented for the IUD placement. Because the visit didn't go as planned and the ob-gyn discussed other birth control methods, you might be tempted to report an office visit (99201-99215, Office or other outpatient visit ...) -- but here's the catch: Your ob-gyn's documentation must support using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Because the birth control discussion directly related to the IUD insertion, you don't have a separate service to report the office code. What about the supply codes? The ob-gyn did use two IUDs and contaminated both. Before you contemplate tacking on J7300 (Intrauterine copper contraceptive) or J7302 (Levonorgestrel-releasing intrauterine contraceptive system, 52 mg) to your claim, you should know that "you cannot bill the patient or insurance" when your practice still retains the IUDs, says Leslie Stewart, BBA, insurance supervisor of Oakwood Women's Centre, PA in Round Rock, Texas. "Contact the supplier and see if they will replace them, as your practice is now out the expense of these two IUDs." Overlooking ICD-9 Could Cost You -- Big For your primary diagnosis, you can use only V25.42 (Surveillance of previously prescribed contraceptive methods; intrauterine contraceptive device). But that will change as of Oct. 1. ICD-9 2011: V25.11 -- Encounter for insertion of intrauterine contraceptive device V25.12 -- Encounter for removal of intrauterine contraceptive device V25.13 -- Encounter for removal and reinsertion of intrauterine contraceptive device In this case, if this scenario took place after October, you would report V25.11. "I like the new specificity with these IUD insertion, removal, and combined codes," says Jan Rasmussen, PCS, CPC, ACSOB, ACS-GI, owner and consultant of Professional Coding Solutions in Holcombe, Wis. Controversy: