Ob-Gyn Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.   Question: My physician insists on billing a pessary fitting as 57160, and then also billing for vaginal irrigation (57150). She is doing the irrigation due to recurrent leukorrhea and to clean out the cavity prior to reinserting the pessary. But according to the correct coding initiative (CCI) edits, these are bundled together. What is the proper coding here?
Kentucky Subscriber
  Answer: As long as you have medical necessity (leukorrhea, 623.5) to support the "additional" service, you can report 57150 (irrigation of vagina and/or application of medicament for treatment of bacterial, parasitic, or fungoid disease) with modifier -59 (distinct procedural service). The CCI edit is a standard-of-care edit meaning "routine" irrigation would be considered an inherent part of pessary fitting (57160, fitting and insertion of pessary or other intravaginal support device).
 If this is an ongoing problem and the physician is having to reinsert the pessary, it is not a pessary "fitting." Fitting codes would only be billed when the patient is initially measured for a pessary or if the patient needs to be remeasured for a new size of pessary. Removing and cleaning is not the same thing as "fitting." Removing and cleaning does not have a procedure code and should be reported with an E/M code, 99211-99215.