# Well woman exam and iud removal-answer needed quickly please!!



## ebredehoeft (Nov 15, 2010)

If a patient came in for a well woman exam, pap, and decided to have her IUD removed, would the removal be included in the preventive well woman exam? I have seen other postings that say you can put a modifier on the preventative. I thought you could only put modifier 25 on problem focused exams. Can anyone direct me to correct documentation about this?

Thanks


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## Teresa Collins (Nov 15, 2010)

According to CPT, modifier 25 is used on _significant, separately identifiable *evaluation and management* service by same physician....._; therefore it would not be used on the preventive visit.  Couldn't you use CPT 58301 for the IUD removal?  

Hope this helps!


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## tburlingham (Nov 15, 2010)

You can bill these two together without modification.  Make sure you have the correct Dx code on the removal as it should not be the same as the preventive visit.


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## preserene (Nov 15, 2010)

V 25.42 for diagnosis code


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## ebredehoeft (Nov 16, 2010)

Thank you. I wasn't sure if I had to use a modifier 25. And I didn't think you could use the modifier on Preventive Visits. Thanks everyone!!


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## preserene (Nov 16, 2010)

Modifier 25 should be added to the OV/outpatient E/M code to indicate it is a separate and identifiable E/M Service, and not to the preventive medicine Service  code in such scenario of another E/M service, the way the guideline directs. But I feel there is no need for  appending to procedural code  as in your case. Any one who could second it please/


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## coding303 (Nov 16, 2010)

A 25 modifier should be added to the preventative visit because you are performing a seperate procedure.  Most physicians will not bill a E/M visit along with preventative and removal, but you can...it just may not be covered with the removal code.  For the removal use 58301 w/ Dx v25.12


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## preserene (Nov 16, 2010)

Can you throw some light( with pertinent guidelines ) upon your statement of adding 25 to the Preventive med Services. Because I do not have one such.
Secondly, there is no 5th digit showing up in the ICD-9 CM -2009 for your 25.12. There is ONLY  upto V25.1(4th digit). which describes " INSERTION OF  IUD ". WHICH IS NOT CORRECT FOR THIS , because she needed *removal. 
*
*The one I said is V25.42- Checking, reinsertion, OR REMOVAL of IUD *


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## coding303 (Nov 16, 2010)

*please review ICD-9*

I understand your question and I provided correct Dx for IUD removal.  I may not have understood what date of service you are coding for.  As of October 1, 2010 V25.1 has been deleted, and replaced.  The correct Dx would be *V25.12 "Encounter for removal of intrauterine contraceptive device"*.  Are you coding from last years ICD-9, or for a date of service prior to that?  You can find a handy sheet of some of the most used Dx in Septembers Coding Edge, this one was on page 18.

It may be handy to know if your office is like most OBGYN offices that V25.11 is for insertion of IUD, and V25.13 ir for removal AND reinsertion of IUD


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## preserene (Nov 16, 2010)

Yes you are right . I have not updated my brain matters yet ! I  did not have the occasion yet.
Thank you


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