Ob-Gyn Coding Alert

Find out if the ob-gyn did a refitting at the time of an insertion If you think 57160 is all you need for pessary insertion procedures, think again. Not only will you have to consult the HCPCS and ICD-9 manuals, you must follow your practice's policy on whether the patient or you are responsible for the supplies. What it is: A pessary is a support device for pelvic-floor weakness, such as uterine prolapse, vaginal prolapse (enterocele, cystocele, rectocele), and stress urinary incontinence. The pessary device is the most common -- and occasionally the only -- nonsurgical option for treating advanced uterine prolapse. Tip 1: Use 57160 for New Pessaries Only CPT provides you with only one code for pessary insertion: 57160 (Fitting and insertion of pessary or other intravaginal support device). This code has no global days. "You-ll only bill 57160 for the original insertion or insertion of a new pessary," says Carlos Marquez, CPC, practice manager for Osborn OB/GYN in Phoenix. Example 1: The patient presents for her yearly examination, and the ob-gyn decides to fit her with a pessary and insert it during the same visit. You should still report 57160 in addition to the exam code (such as 99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ..., or 99395-99397, Established patient preventive medicine service). Remember to add modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M or preventive service. Example 2: A Medicare patient is eligible for her screening pelvic and breast exam, and during this visit the ob-gyn inserts a pessary. You should report the pessary insertion with 57160 in addition to G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination). Red flag: If the patient returns for the cleaning and reinsertion of the pessary, you should report the E/M code for an established patient visit (99211-99215), depending on the examination and medical decision-making your ob-gyn documents in the chart. You would not include 57160. You-ll include the cleaning and reinsertion in the E/M, says Karen A. O-Malley, office manager for an ob-gyn practice in Arlington Heights, Ill. - New pessary is key: The only way you could report 57160 again would be if the ob-gyn resized the patient and inserted a new pessary, says Nicole Martin, billing coordinator at The Institute for Female Pelvic Medicine & Reconstructive Surgery in Allentown, Pa. Tip 2: Keep A4562 Handy Medicare considers pessaries both a supply and an orthotic. You should report them using the following HCPCS codes: - A4561 -- Pessary, rubber, any type - A4562 -- Pessary, nonrubber, any type. Common: [...]