# IUD letter from ACOG - Help please



## anthemfamily (May 19, 2009)

I had an email forwarded to me from ACOG.  They are saying to bill a discontinued IUD with a modifier -53.  We do not use anethesia with our insertions.  My understanding is that -53 is for dicontinued procedures after anesthesia was given.  I have always billed as -52.  

Also they are telling us that insertion/removal on same day are not inclusive and we should be billed seperately.  In the past I have been told, in seminars and by ins co's that removal is included in re-insertion.

Now I am thinking I am crazy, I love when the non CPC's tell me how to code.  Before I argue the point I want to make sure I am correct.  Any feedback would be greatly appreciated!!!!

Traci, CPC


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## ciphermed (May 19, 2009)

Appendix A in CPT does not indicate that anesthesia must be used when utilizing this modifier, the note indicates the modifier is not used to report the elective cancellation of a procedure prior to pt induction of anesthesia and/or surgical prep in the OR.

Modifier's -73 & -74 are used by Outpatient Hospitals & ASC's to report discontinued procedure(s) that require anesthesia.

It would appear to be appropriate to use the -53 in the case of the discontinued IUD insertion without anesthesia.

There is coding information which indicates that the removal of an IUD is not included in the insertion, therefore both would be reported when performed.

Hope this helps,


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## cgallimore (May 19, 2009)

I agree with the response regarding the use of the 53 modifier. However, in the 2009 OBGYN Coding Companion, it states that if an IUD is removed and another is inserted at the same time, only the insertion (58300) should be reported. 

Cindy Gallimore, CPC


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## Lisa Bledsoe (May 19, 2009)

cgfreckles said:


> I agree with the response regarding the use of the 53 modifier. However, in the 2009 OBGYN Coding Companion, it states that if an IUD is removed and another is inserted at the same time, only the insertion (58300) should be reported.
> 
> Cindy Gallimore, CPC



According to the statement by ACOG you should bill both 58300 and 58301 separately.  Link:  http://www.acog.org/departments/dept_notice.cfm?recno=6&bulletin=4828


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## imjsanderson (May 20, 2009)

CCI edits and The OB/GYN Coding Companion, do say the removal is incidental to the insertion, BUT, I agree with ACOG and will bill these regardless of the CCI edit and use the ACOG article to appeal if necessary.  Be sure your Doc's document each procedure in a separate paragraph.  We follow ACOG's recommendation.


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## Lisa Bledsoe (May 20, 2009)

I'm looking at the CCI edits right now and I do not see any bundling edits...  I'm using Correct Code Check and Code Manager.


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