# IUD removal and insertion on the same dos



## olgunchik

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.


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## ARCPC9491

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...


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## ciphermed

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.


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## olgunchik

Thank you very much. I guess will bill both and will see what is going to happen.


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## olgunchik

Anthony,
Do you know how can I order CPT Assistant? 
Thanks.


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## ciphermed

amabookstore.com

1 (800) 621-8335

Hope this helps...


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## gsealy

*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.


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## imjsanderson

Recently ACOG put out an article which recommends billing for both the insertion and removal done at the same visit:  whether insurance will pay is another story but we follow ACOG guide lines and I feel we SHOULD bill this way if we are to have anything changed down the road.

http://www.acog.org/departments/dept_notice.cfm?recno=6&bulletin=4828


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## kumeena

gsealy said:


> 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.


 Yes absolutely right. I do follow the same  at my work


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## jonvieve

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 . . . 



-


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## Susan R

*ACOG Article*



imjsanderson said:


> Recently ACOG put out an article which recommends billing for both the insertion and removal done at the same visit:  whether insurance will pay is another story but we follow ACOG guide lines and I feel we SHOULD bill this way if we are to have anything changed down the road.
> 
> http://www.acog.org/departments/dept_notice.cfm?recno=6&bulletin=4828



Thank you very much for posting that ACOG article; immensely helpful! 

Susan Reehill, CPC, CEMC


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## Lisa Bledsoe

*Both*

We code both and get paid for both. We code with modifier -51 on removal.


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## CPalmer

*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.


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## Jamie Dezenzo

*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


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## hjchamas

I use 58300 with 58301-51 for insertion and removal in the same visit.


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## OCD_coder

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.


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## Jamie Dezenzo

Thanks for your help!


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