Wiki Hysteroscopy IUD Removal POS 24 Same Day IUD Insert POS 11

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ConRonda

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Provider performed a hysteroscopy IUD removal (58562) at an outpatient facility then had the patient to come into the office a few hours later for an insert of a new IUD (58300).

I would like thoughts about billing these out. I am concerned with billing that IUD insert in the office same day a Hysteroscopy IUD removal was performed.

The office note does not state why the patient came into the office same day for the insert. Is this necessary?

Should the insert just be billed with a modifier or not at all?
 
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I would bill both services. I don't see a bundling relationship between these codes, so you shouldn't need a modifier. But even if there was, you could unbundle with modifier XE or 59, if necessary, since this would be considered two separate encounters on that day.

I suppose it's possible that a payer would request documentation to support medical necessity for the two services on the same day and might argue that the documentation is deficient, though I think that's an unlikely scenario unless this is a pattern with this provider. It would be better if your provider gave some kind of explanation in the notes, but that doesn't mean you shouldn't bill the services. As a coder, you should accurately report the services documented - the medical necessity of those services is up to the provider to determine.
 
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thomas7331 said:
I would bill both services. I don't see a bundling relationship between these codes, so you shouldn't need a modifier. But even if there was, you could unbundle with modifier XE or 59, if necessary, since this would be considered two separate encounters on that day.

I suppose it's possible that a payer would request documentation to support medical necessity for the two services on the same day and might argue that the documentation is deficient, though I think that's an unlikely scenario unless this is a pattern with this provider. It would be better if your provider gave some kind of explanation in the notes, but that doesn't mean you shouldn't bill the services. As a coder, you should accurately report the services documented - the medical necessity of those services is up to the provider to determine.
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Thank you. This is the 1st I've come across this situation.

I was hesitant about billing that IUD insert because of the same day outpatient procedure. But you are correct they are not bundle and are two separate encounters. I looked all over to make sure it was ok. I didn't find a reason I couldn't and figured what better place for input/insight than here.

But I do think I will inform the provider to just do them on separate days just in case....
 
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ConRonda said:
Thank you. This is the 1st I've come across this situation.

I was hesitant about billing that IUD insert because of the same day outpatient procedure. But you are correct they are not bundle and are two separate encounters. I looked all over to make sure it was ok. I didn't find a reason I couldn't and figured what better place for input/insight than here.

But I do think I will inform the provider to just do them on separate days just in case....
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I always recommend that the provider should just be allowed to do what's best for the patient and not be making treatment decisions based on concerns about what or how and insurance company will pay.
 
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I'll just weigh in for WHY this may be occurring from my personal experience. Sometimes facilities (especially ASCs) do not stock or provide IUDs. So they physician may want to insert it at the time of removal, but the device is not available from that location. I agree the clinician should be making the final determination about the patient care, but they should be made aware if this determination results in a non-payable service. Clinicians do actually make treatment decisions all the time based on what or how an insurance company will pay, particularly when it comes to prescription medications. Most patients are not going to pay $200/month for a drug not on their formulary and the physician will change the medication to something comparable.
 
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