Wiki Two IUDs placed same day/same visit

[britbrit852003]

I have a weird scenario. Patient came in for IUD insertion. The provider inserted a Paraguard IUD. Once it was in the patient started questioning the side effects and if she would bleed. Once the patient found out she would experience bleeding she said she wanted the Mirena IUD instead.
So the provider took out the Paraguard and inserted the Mirena.
I have no clue how to bill this. Would I bill two 58300 and one 58301 and both of the IUDs?
Any advice on how to bill would be appreciated.
Thanks

 

[phyco10]

I have an opinion on this scenario mostly because I have been on the Provider side and the Payor side, more so than Coding per se. Fully realizing that I do not have all the background information on this encounter, from the Payor (and Provider) side, it appears that there was either insufficient counseling of this patient or the patient did not fully comprehend the risks, benefits, side effects, etc of the first IUD. Efficient utilization of resources is an issue here and, subsequently, who assumes the responsibility for their cost.

I think that billing for an IUD Insertion, 58300, is appropriate and also for the Mirena IUD if it is not bundled with the insertion. (Medicare et al may not cover the IUD separately). Billing for the first IUD and its removal on the same DOS, for the reasons mentioned, would definitely be reviewed by the Payor, in my opinion. Judicious use of Modifiers to mitigate the expense may be acceptable for the latter two codes. This case is "weird" in that this scenario should rarely occur.

Just my thoughts and look forward to other inputs.

With Best Regards,

Robert Billerbeck, MD CPC
Meditco LLC