Ob-Gyn Coding Alert

Question: During a postpartum visit, the patient wants the physician to insert an intrauterine device (IUD). For coding purposes, is performing this procedure during the postpartum visit wise or should we ask her to come back for a separate visit to insert the IUD?

Ohio Subscriber

Answer: Although the global ob period includes discussion of birth control, it does not include IUD insertion. You should code the procedure (58300*, Insertion of intrauterine device [IUD]) separately from the global period.

You can code for any service that is unrelated to recovery from the delivery and pregnancy, even when it occurs during a normal postpartum visit. If the unrelated visit is strictly an E/M service (99211-99215), you should add modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M code to show that it is separate from the global ob period.

If the ob-gyn just inserts the IUD at the time of the postpartum visit, you should bill 58300 without a modifier because you are not billing for a postpartum check as an E/M service, and the procedure then looks like a stand-alone service.

On the other hand, if the physician provides a problem-oriented E/M service in addition to the IUD insertion at the time of the postpartum check, you should append the E/M code with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to show that it is unrelated to the global ob package and the IUD insertion.

The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.