Ob-Gyn Coding Alert

Question: When we do an intrauterine device (IUD) insertion and removal on the same day, we have been billing:

·         58301

·         58300-51.

We bill this way based on the relative value units (RVUs) being higher for the removal. Is this correct or should there be another way to bill? Lately we have a few payers paying 100% on both procedures. I want to make sure we are coding correctly on our end because the way they are paying seems incorrect. We have questioned the payer and received the following response:

Based on the Federal Register, 58300 has a designation of “9” under multiple surgery which means multiple surgery concept does not apply . “XXX” global days do not apply. 58301 has a designation of “2” meaning multiple surgery applies and “000” same day E/M is not covered on the day of the procedure. If you have a “9” code and a “2” code billed together, the multiple surgery rules will not fire. This is why you are not seeing a payment reduction on 58300.

Is this correct?

North Carolina Subscriber

Answer: This payer’s logic is flawed, because Medicare does not cover 58300 (Insertion of intrauterine device [IUD]) under any circumstances, which is why it is designated an XXX and “9.” 

Therefore, you should continue billing as you have been for these two. 

If you run into a payer that only reimburses for one of these codes, bill them as 58301-22 (Removal of intrauterine device [IUD]; Increased procedural services) only.

But if your payer wants to pay you in full for both, then that is their policy. Just make sure you continue to use the multiple procedure modifier (51) in case they change their minds later. Using modifier 51 protects you from having to pay back money, since you clearly indicated the insertion was a multiple procedure.