Wiki IUD removal coding issue

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bessiebradley

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We had a patient present to the office for copper 7 IUD removal. During the removal the arm of the IUD broke off and remained in the uterus. Hysteroscopy was performed unsuccessfully in an attempt to retrieve the IUD arm.
At that point, decision was made to take the patient to the OR to remove the IUD arm. Insurance was billed 99214-57-25, 58301, 58555-51 location office and 58562 location outpatient. Any suggestions on how to code the office procedures? Thanks
 
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Hello! That’s a complicated one!
So the patient presented for IUD removal (58301) but the IUD broke. Since the removal was completed, I would still bill 58301 for in the office, but be sure to use the DX T83.39XA to explain that the IUD broke.
I wouldn’t bill 58558 (diagnostic hysteroscopy), since the provider did a more extensive version of that procedure in the OR on the same day. Per CMS, diagnostic laparoscopy/endoscopy is included in the surgical endoscopy, and that rule would still apply to Hysteroscopy.
I wouldn’t use modifier 57 either, since that modifier is for major procedures only. CPT 58562 has 0 global days (minor surgical procedure), so the 99214 is not billable. CMS again has a rule that E/M codes for the same problem are not reportable on the same DOS as a minor surgical procedure, unless significant work beyond the preop/postop work was done. The in-office 58301 has an inherent E/M already, as does 58562. Unless other problems were managed at that visit (discussing other forms of contraceptives, managing pain, etc)...So here is how I would code it:

In office: 58301-59, Z30.432, T83.39XA
In OR: 58562, Z30.432, T83.39XA
I don’t currently have the NCCI edits open, but I imagine there’s a rule for 58562/58301. If so, use modifier 59. If you can look up the NCCI edits and there is no rule For those two codes, use modifier 51.
 
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ELBrock said:
Hello! That’s a complicated one!
So the patient presented for IUD removal (58301) but the IUD broke. Since the removal was completed, I would still bill 58301 for in the office, but be sure to use the DX T83.39XA to explain that the IUD broke.
I wouldn’t bill 58558 (diagnostic hysteroscopy), since the provider did a more extensive version of that procedure in the OR on the same day. Per CMS, diagnostic laparoscopy/endoscopy is included in the surgical endoscopy, and that rule would still apply to Hysteroscopy.
I wouldn’t use modifier 57 either, since that modifier is for major procedures only. CPT 58562 has 0 global days (minor surgical procedure), so the 99214 is not billable. CMS again has a rule that E/M codes for the same problem are not reportable on the same DOS as a minor surgical procedure, unless significant work beyond the preop/postop work was done. The in-office 58301 has an inherent E/M already, as does 58562. Unless other problems were managed at that visit (discussing other forms of contraceptives, managing pain, etc)...So here is how I would code it:

In office: 58301-59, Z30.432, T83.39XA
In OR: 58562, Z30.432, T83.39XA
I don’t currently have the NCCI edits open, but I imagine there’s a rule for 58562/58301. If so, use modifier 59. If you can look up the NCCI edits and there is no rule For those two codes, use modifier 51.
Click to expand...

Here are my sources:
CMS global surgery packet: https://www.cms.gov/outreach-and-ed...oducts/downloads/globallsurgery-icn907166.pdf

 
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