I hope someone else has come across this situation...
One of my Gyn Oncologists removed an IUD that was broken apart and stuck in the patient's cervix. This required the cervix to be dilated and the IUD removed in pieces. I have confirmed that an EUA and cervical dilation are bundled in with the IUD removal (CPT 58301 for removal; Bundled CPTs 57410 and 57800). The work put into removing this IUD seems to me to be worth more than the $139 fee and minimal RVUs associated. I know I could add a 22 modifier, but does anyone else have any code suggestions? Procedure details below. I appreciate any input!
Procedure in Detail
After informed consent was obtained, patient was taken to the operating room where she underwent endotracheal anesthesia. Once this was found to be adequate, she was prepped and draped in the usual fashion for vulvovaginal surgery using the low Allen stirrups for dorsal lithotomy position. Bladder was drained sterilely and antibiotics were given. We used retractors to visualize the cervix and did not initially visualize any strings. I did palpate the cervix and could feel the tip of the IUD in the proximal cervix. I used a Bozeman clamp and grasped this distal end. This portion broke off. I grasped another portion which also broke out. At that point, I decided to dilate the cervix and see if that would help us remove the rest of the IUD. I grasped the cervix with a single tooth tenaculum. I then dilated the cervix using the Heaney dilators. I was then able to grasp higher on the IUD near the T portion and then was able to gently work this free from the cervix. This was removed intact and evaluated with the additional portions to see that the IUD had been removed completely. There was minimal bleeding, the tenaculum was removed and the sites were noted to be hemostatic. The retractors were removed, the patient was taken out of the stirrups, awakened, extubated, and taken to the recovery room in stable condition. She tolerated the entire procedure well.
One of my Gyn Oncologists removed an IUD that was broken apart and stuck in the patient's cervix. This required the cervix to be dilated and the IUD removed in pieces. I have confirmed that an EUA and cervical dilation are bundled in with the IUD removal (CPT 58301 for removal; Bundled CPTs 57410 and 57800). The work put into removing this IUD seems to me to be worth more than the $139 fee and minimal RVUs associated. I know I could add a 22 modifier, but does anyone else have any code suggestions? Procedure details below. I appreciate any input!
Procedure in Detail
After informed consent was obtained, patient was taken to the operating room where she underwent endotracheal anesthesia. Once this was found to be adequate, she was prepped and draped in the usual fashion for vulvovaginal surgery using the low Allen stirrups for dorsal lithotomy position. Bladder was drained sterilely and antibiotics were given. We used retractors to visualize the cervix and did not initially visualize any strings. I did palpate the cervix and could feel the tip of the IUD in the proximal cervix. I used a Bozeman clamp and grasped this distal end. This portion broke off. I grasped another portion which also broke out. At that point, I decided to dilate the cervix and see if that would help us remove the rest of the IUD. I grasped the cervix with a single tooth tenaculum. I then dilated the cervix using the Heaney dilators. I was then able to grasp higher on the IUD near the T portion and then was able to gently work this free from the cervix. This was removed intact and evaluated with the additional portions to see that the IUD had been removed completely. There was minimal bleeding, the tenaculum was removed and the sites were noted to be hemostatic. The retractors were removed, the patient was taken out of the stirrups, awakened, extubated, and taken to the recovery room in stable condition. She tolerated the entire procedure well.
