Wiki IUD removal and insertion on the same dos

olgunchik

Contributor
Messages
24
Location
Pardeeville, WI
Best answers
0
Help please! If previous IUD was removed and new IUD was insterted on the same dos, how do we bill it? Do we need modifier?
Situation is that pt was seen previously for vaginal bleeding. Ultrasound revealed IUD is likely a cause for the bleeding. So, pt came in for replacement.
Thank you for your help.
 
Not my area of expertise but my opinion is the removal would be included in the original insertion of the IUD. If this is not the case, then I would code the CPT with the highest RVU first, and second with modifier 51. BUT... I'd be inclined to code only the insertion...76 modifier, "repeat procedure by same physician" might be necessary...

Just a few thoughts...
 
There is a CPT Assistant (1998) that addresses removal & insertion of IUD's on the same d.o.s....

The response was that the insertion does not include the removal...although payors may vary... So it appears that coding both should be fine unless a specific payor has different requirements.
 
IUD insertion/removal

2008 OB/GYN coding companion states - If an IUD is removed and another is inserted at the same time, only the insertion (58300) should be reported.
 
Insertion of IUD does include removal. I think the CPT's reasoning is that an old IUD woud be remove and replaced with a new at the same time of service. Removing an IUD is a snap in most cases, just comes right out with a light pull, so it seems fair to me that the removal of the previous IUD be included in the insertion of the new IUD. If the removal is difficult that is another story . . .



-
 
Last edited:
IUD Removal/Insertion Coding

My office bills for the removal, insertion, and device w/o a modifier. If you are billing Regence, a modifier -59 is needed on the removal. Use a -25 on the e/m code if you are billing with the removal/insertion/device.:)
 
removal and insert IUD same day

Article no longer available but did find per ACOG article how to properly code for IUDs.

Can ob/gyn coders very billing both 58300 and 58301 or just 58300

replacing IUD and coding for ASC side.

Thanks!

Jamie
 
This from Encoder Pro:

These procedures may be performed by a registered nurse, physician assistant, nurse practitioner, or other trained paramedical person under a physician's supervision. For IUD removal and insertion of a new device during the same visit, report both the IUD removal (58301) and insertion (58300) codes separately. The cost of the IUD is not included in these codes and should be reported separately using the appropriate HCPCS Level II code. These procedures are usually not done out of medical necessity; therefore, the patient may be responsible for charges. Verify with the insurance carrier for coverage. Local anesthesia is included in these services. Surgical trays, A4550 may be separately reimbursed by third-party payers. Check with the specific payer to determine coverage.
 
does anyone know if it'll get denies if the removal was done by the aprn and she had trouble inserting the new one so the doc came in and the insertion was done under the doc. half the visit it under aprn and half is under the doc and not sure if I should just put it all under the doc if I can legally if they cosigned the note?
 
does anyone know if it'll get denies if the removal was done by the aprn and she had trouble inserting the new one so the doc came in and the insertion was done under the doc. half the visit it under aprn and half is under the doc and not sure if I should just put it all under the doc if I can legally if they cosigned the note?
If the physician determined the plan of care was to remove the IUD and the NPP removes it in office when the physician is onsite and immediately available, AND the carrier follows incident-to, then I would bill that service under the physician.
https://www.cms.gov/outreach-and-ed...k-mln/mlnmattersarticles/downloads/se0441.pdf gives examples of services other than E&M which still can fall under incident-to (like cardiac rehab, injections).
 
If the physician determined the plan of care was to remove the IUD and the NPP removes it in office when the physician is onsite and immediately available, AND the carrier follows incident-to, then I would bill that service under the physician.
https://www.cms.gov/outreach-and-ed...k-mln/mlnmattersarticles/downloads/se0441.pdf gives examples of services other than E&M which still can fall under incident-to (like cardiac rehab, injections).
I would have to disagree that the removal of an IUD qualifies as "incident to" service. The full example in this link states "Examples of qualifying “incident to” services include cardiac rehabilitation, providing non-self administrable drugs and other biologicals, and supplies usually furnished by the physician in the course of performing his/her services (for example, gauze, ointments, bandages, and oxygen)." In no way would the removal fall into this example category. If the insurer does not allow direct billing by the NNP and their policy states that it can be billed by the supervising MD, then bill away. Otherwise I think this practice may be in trouble during an audit.
 
I would have to disagree that the removal of an IUD qualifies as "incident to" service. The full example in this link states "Examples of qualifying “incident to” services include cardiac rehabilitation, providing non-self administrable drugs and other biologicals, and supplies usually furnished by the physician in the course of performing his/her services (for example, gauze, ointments, bandages, and oxygen)." In no way would the removal fall into this example category. If the insurer does not allow direct billing by the NNP and their policy states that it can be billed by the supervising MD, then bill away. Otherwise I think this practice may be in trouble during an audit.
That is not how I am interpreting the document. I will check for additional references. Some excerpts:
“Incident to” services are defined as those services that are furnished incident to physician professional services in the physician’s office (whether located in a separate office suite or within an institution) or in a patient’s home.
To qualify as “incident to,” services must be part of your patient’s normal course of treatment, during which a physician personally performed an initial service and remains actively involved in the course of treatment. You do not have to be physically present in the patient’s treatment room while these services are provided, but you must provide direct supervision, that is, you must be present in the office suite to render assistance, if necessary. The patient record should document the essential requirements for incident to service.
More specifically, these services must be all of the following:
• An integral part of the patient’s treatment course;
• Commonly rendered without charge (included in your physician’s bills
• Of a type commonly furnished in a physician’s office or clinic (not in an institutional setting); and
• An expense to you.
An IUD removal (if already determined to be the treatment plan by physician) meets all 4 of those.
 
MAC Noridian states this:
Services performed by these nonphysician practitioners 'incident to' a physician's professional services include not only services ordinarily rendered by a physician's office staff person (e.g. medical services such as taking blood pressure and temperatures, giving injections and changing dressings), but also the services ordinarily performed by the physician himself or herself such as minor surgery, setting casts or simple fractures, reading X-rays and other activities that involve evaluation or treatment of a patient's condition.

I see no reason an IUD removal could not be included in this.
 
MAC Noridian states this:
Services performed by these nonphysician practitioners 'incident to' a physician's professional services include not only services ordinarily rendered by a physician's office staff person (e.g. medical services such as taking blood pressure and temperatures, giving injections and changing dressings), but also the services ordinarily performed by the physician himself or herself such as minor surgery, setting casts or simple fractures, reading X-rays and other activities that involve evaluation or treatment of a patient's condition.

I see no reason an IUD removal could not be included in this.
Thank you so much for all the info you gave in this thread!
 
Top