Wiki Coding for pessary

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New patient came in to be evaluated for a uterine prolapse. During this appointment, she was examined and offered options to address it. The patient stated she would like to try the pessary and scheduled to come in on a different date for the fitting. She came in then for a fitting prior to device being ordered. She is scheduled to come in soon for the insert.Would I need to code the day she came in for a fitting as 99212 and insert as 57160?
 
Usually that is all done at the same session, and 57160 includes fitting and placement. For my two cents, I would bill 57160 for the fitting, and wouldn't bill additionally for the insert.

Clinical Responsibility
The provider performs a vaginal exam to determine the proper type and size of pessary; he may try multiple sizes until he finds the correct fit. The provider will also check for possible incontinence once the pessary is in place and will instruct the patient on how to insert, remove, and clean the pessary. The provider will ask the patient to walk with the pessary in place, and then the provider will reexamine the vagina to ensure the pessary is still correctly in place.
 
I agree with @Cmama12. I would bill 57160 for the day of the actual fitting. Generally, for practices that treat a lot of prolapse, they keep various types/sizes of pessaries in stock so the fitting and the insertion are the same day. If that is not how this practice operates, I also would not charge additionally for when the patient needed to return for insertion. I might create a dummy code in my EHR system to help track how often this takes place and to reconcile the appointments.
 
i also always thought that the eval and fitting were included in 57160 but i looks like i'm mistaken according to this one source coding intel. any thoughts? thanks guys!

pessary.PNG
 
Evaluation is not included. 57160 covers the fitting and insertion. If they are coming in for evaluation and then the fitting, etc is done, you can bill a separate E+M.
 
Korbc said:
i also always thought that the eval and fitting were included in 57160 but i looks like i'm mistaken according to this one source coding intel. any thoughts? thanks guys!

View attachment 8265
Click to expand...
Here this clinical vignette used to add this code to CPT and to value the code:

typical patient: A 74-year-old gravida 4, para 4 (G4P4) postmenopausal female presents with cystocele and uterine prolapse. In addition, she suffers from chronic obstructive pulmonary disease (COPD), which makes her a poor candidate for surgical intervention. Pelvic examination reveals that her prolapse is reducible and that she has no evidence of laceration or ulceration of the vaginal mucosa. Insertion of a pessary or intravaginal support device is recommended.
pre service info: Explain in detail the procedure of pessary fitting. Drape the patient and position comfortably in a lithotomy position.
intra service info: 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.
post service info: Observe patient for stability after completion of the multiple position changes and provocative valsalva maneuvers. Document the multiple pessary types and sizes attempted with reporting of expulsions and description of the provocative maneuvers for each attempted pessary. Document plan for removal and cleaning of the pessary.
 
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