Wiki IUD insertion problem

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mmckibbin

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We had a new patient come in for an IUD removal and reinsertion. We were about to remove the old IUD without problem, however when it came to reinsertion we couldn't get the IUD past the cervix. We used dilators but still couldn't get it inserted. So we opened a Mirena and was able to insert that without problem. However because the failed insertion of the Liletta was due to body difficulties not device failure we are unable to get a replacement from Liletta. Are we just out the supply and have to eat the cost of that Liletta or is there a way to bill the insurance and get reimbursed from them? Has anyone else come across this and actually gotten it paid by insurance?

Can you use CPT modifier -52 on J7297? I know we use some HCPCS modifiers like LT but I'm unsure if all modifiers can be used interchangeably.
 
-52 is not a valid modifier for J7297 and I don't think would be appropriate in this scenario anyway. You could consider -53 or perhaps -JW.
Before billing insurance, I would at least ASK my rep to consider replacing.
I have no firsthand experience to advise whether or not an insurance would pay.
Good luck!
 
mmckibbin said:
We had a new patient come in for an IUD removal and reinsertion. We were about to remove the old IUD without problem, however when it came to reinsertion we couldn't get the IUD past the cervix. We used dilators but still couldn't get it inserted. So we opened a Mirena and was able to insert that without problem. However because the failed insertion of the Liletta was due to body difficulties not device failure we are unable to get a replacement from Liletta. Are we just out the supply and have to eat the cost of that Liletta or is there a way to bill the insurance and get reimbursed from them? Has anyone else come across this and actually gotten it paid by insurance?

Can you use CPT modifier -52 on J7297? I know we use some HCPCS modifiers like LT but I'm unsure if all modifiers can be used interchangeably.
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You would not use a modifier -52 on J7297 - you did not provide a reduced service and this is a code for a supply not a service. If Lilleta will not reimburse you, I'm afraid you are out of luck. But if the Mirena fit, the Lilleta should also have fit as they are both 1.3 x 1.3 inches. The inserter is also about the same as with that used for Mirena.
 
I think she's thinking of 52 on the iud insertion attempt because for instance the Bayer company/brand IUD guide says to use 52 specifically for that reason I have a picture of it but it says the image is to large to attach in this thread, but if you wanted to look at it I could email it to you
 
mmckibbin said:
The inserter for the liletta didn't work because it was to rigid. The mirena inserter is more flexible and her canal was angled.
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yeah so Bayer's iud guide says to use 52 if it's discontinued for anatomical reasons and then 53 for quote "provider couldn't complete procedure due to concerns for patient's well being, severe pain, vasovagal, or the patient changed their mind" but that's just Bayer. Traditionally your taught to use the 53. Although doesn't seem like Bayer is the manufacturer of liletta, they make kyleena,mirena, and skyla. But this is the reason why I thought you were thinking of putting 52 on it
 
Korbc said:
I think she's thinking of 52 on the iud insertion attempt because for instance the Bayer company/brand IUD guide says to use 52 specifically for that reason I have a picture of it but it says the image is to large to attach in this thread, but if you wanted to look at it I could email it to you
Click to expand...
But what she said was could she use the -52 on the J code (note the insertion code).
 
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