Wiki E/M w/IUD removal/insert

[bonnienorth55]

Hi all, I'm looking to get some input on this denial I'm dealing with: The patient came in for an IUD check back on 10/05/2021 (was having issues and was undecided if she wanted to try and replace it). She requested a replacement visit a little over a year later on 11/03/22 and had her IUD replaced on 01/18/23. We billed out the IUD insert and removal along with 99214-25. United Healthcare is denying the 99214-25 as bundled. I initially thought that the E/M should not have been billed as this was strictly for the IUD replacement (no counseling/other concerns brought up during her visit). But given that her appt was back in 2021, I'm wondering if I'm incorrect and we should be able to bill out the consult code as well? Any thoughts/advice would be greatly appreciated! Thanks in advance!

 

[csperoni]

It doesn't matter when the provider last saw the patient. If the encounter does not have a significant and separately identifiable E&M service, it should not be billed.
Whenever someone is waffling about a visit with a procedure, here's my advice: Take the note and cross out everything that is related to the procedure. That give you the separately identifiable part. If what is left is also significant, then level the visit based on the leftover with -25. If the leftover is not significant, then it is only a procedure.

 

[bonnienorth55]

Thank you so much for that advice! That will be very helpful in not overthinking these kinds of situations. Appreciate your help

 

[twizzle]

At the visit on 11/3/22 was it documented that the patient would attend at a later date (1/18/23) to have the device replaced? If so, and no other problems were addressed unrelated to the IUD, then there is no separately identifiable E/M service.
csperoni provided good advice.

 

[bonnienorth55]

At the visit on 11/3/22 was it documented that the patient would attend at a later date (1/18/23) to have the device replaced? If so, and no other problems were addressed unrelated to the IUD, then there is no separately identifiable E/M service.
csperoni provided good advice.

They counseled her on that and said that it's up to her if she would like to come back and have it replaced. It was that so much time had passed between then and her return visit that was throwing me off. Thank you for your input!