# Hysteroscopic IUD removal



## dehrensberger1 (Mar 12, 2021)

How is everyone coding a hysteroscopic removal of IUD when there are lost strings?  I am using 58562 but am questioning if that is correct?  Any insight would be appreciated.  Thanks!


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## such78 (Mar 12, 2021)

I was told to use this code. Your primary dx is T8332XA.


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## csperoni (Mar 13, 2021)

58562 would be if the IUD is impacted.  If the hysteroscopy is just to remove a non-impacted IUD because the strings are lost, 58562 is not the correct code.  There is no exact code for that scenario, but I use 58555.  
Per an article in AAGL https://newsscope.aagl.org/decoding-coding/office-hysteroscopy/
-An established patient presented for IUD removal. No strings were present on exam. I used the hysteroscope to find the strings and remove the IUD, but the IUD was not impacted. How do I code for this?
-There are two possible options. First, code a 58301 (Removal of IUD) with a -22 modifier to represent the additional work of the hysteroscope. It would be important to include the cost of the equipment that was separately used for the hysteroscope in the bill to the insurance company.  Second, code a 58555 much like one might perform and bill for an ultrasound to confirm the presence of the IUD if the practice did not have access to office hysteroscopy. If the IUD was impacted or embedded into the myometrium, the documentation must clearly state that it was indeed impacted and then the 58562 code would be appropriate. Because she was an established patient and she came in purely for the IUD removal, there is no E&M to be coded. It would not be appropriate to bill for an ultrasound that showed a normally placed IUD and a 58555 since the hysteroscopy was used solely to find the strings and not to see if the IUD was impacted.


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## such78 (Jun 18, 2021)

csperoni said:


> 58562 would be if the IUD is impacted.  If the hysteroscopy is just to remove a non-impacted IUD because the strings are lost, 58562 is not the correct code.  There is no exact code for that scenario, but I use 58555.
> Per an article in AAGL https://newsscope.aagl.org/decoding-coding/office-hysteroscopy/
> -An established patient presented for IUD removal. No strings were present on exam. I used the hysteroscope to find the strings and remove the IUD, but the IUD was not impacted. How do I code for this?
> -There are two possible options. First, code a 58301 (Removal of IUD) with a -22 modifier to represent the additional work of the hysteroscope. It would be important to include the cost of the equipment that was separately used for the hysteroscope in the bill to the insurance company.  Second, code a 58555 much like one might perform and bill for an ultrasound to confirm the presence of the IUD if the practice did not have access to office hysteroscopy. If the IUD was impacted or embedded into the myometrium, the documentation must clearly state that it was indeed impacted and then the 58562 code would be appropriate. Because she was an established patient and she came in purely for the IUD removal, there is no E&M to be coded. It would not be appropriate to bill for an ultrasound that showed a normally placed IUD and a 58555 since the hysteroscopy was used solely to find the strings and not to see if the IUD was impacted.


Hello Christine,

Which CPT code(s) do you suggest to assign for IUD removal (not impacted) with hysteroscopy and D&C (path is normal) at the same encounter? Will be correct to use 58562?

Can code retained IUD as T19.3XXA- foregin body in uterus, initial encounter or Z97.5 IUD present?


Thank you.


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## csperoni (Jun 18, 2021)

58562 Hysteroscopy, surgical; with removal of impacted foreign body
If the IUD is not impacted, you should not choose removal of impacted foreign body.
For IUD removal and hysteroscopy with D&C, I would code
58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C                                   
58301 Removal of intrauterine device (IUD)

T19.3XXA Foreign body in uterus, initial encounter
Parent Code Notes: T19
Excludes2: complications due to implanted mesh (T83.7-)
_*mechanical complications of contraceptive device (intrauterine) (vaginal) (T83.3-)*_
presence of contraceptive device (intrauterine) (vaginal) (Z97.5)
The excludes guidance tells you not to use for IUD.  I would consider Z30.432 or T83.3- based on clinical information.


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## such78 (Jun 18, 2021)

Thank you.


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