Question Is IUD removal billable if only removed due to pt coming in for colposcopy?

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boothwyn, PA
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Is IUD removal billable if pt comes in for a procedure (for example, colposcopy w ECC and BX (57454)) and provider documents she removes pt's IUD as part of colposcopy- is the removal inclusive to 57454 or is 58301 iud removal billable? Thanks in advance!
 

Cmama12

Guru
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We do bill these out together as well as with sterilization procedure etc. As far as I am aware, these have been paid without issue.
 

ckhang

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We do bill these out together as well as with sterilization procedure etc. As far as I am aware, these have been paid without issue.
Hi Cmama12. I'm located in MN and whenever I bill CPT codes 57454 and 58301 and/or 58300 vice versa together insurance always denies the 57454 and pays for the IUD removal/insertion. Would you recommend using modifier 51 or 59 on the IUD insertion and/or removal when billing with 57454 or any code in that code series? Any advice would be greatly appreciate it. Thank you in advance. :) - Choua
 

csperoni

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Selden
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The codes are not CCI edits and -59 or -X__ is not required unless there is a carrier policy.
Is the denial for bundling or for another reason?
If for bundling due to carrier policy, I would add -59 or -X___ depending on carrier's preference. If the denial is bundling, -51 for multiple procedures will not override the edit.
If the denial is for another reason, it would be helpful to know what that other reason is.
 

ckhang

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The codes are not CCI edits and -59 or -X__ is not required unless there is a carrier policy.
Is the denial for bundling or for another reason?
If for bundling due to carrier policy, I would add -59 or -X___ depending on carrier's preference. If the denial is bundling, -51 for multiple procedures will not override the edit.
If the denial is for another reason, it would be helpful to know what that other reason is.
The denial is always "included in another procedure." I've sent supporting documentation to appeal but the insurance company upholds their original decision so we always end up writing-it off. :(
 

csperoni

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Selden
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I would check if they do have a carrier policy regarding this. Many payors add additional edits on top of NCCI edits. In absence of a policy, I would try escalating the issue to anyone who will listen at the carrier. Keep a spreadsheet of the patients since each one is likely a small amount, but it adds up.
 
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