Ob-Gyn Coding Alert

Question: How would you bill this (see below)?

Pt presents today for placement of Mirena IUD. Risk, benefits and alternatives to Mirena IUD discussed with patient and informed consent obtained. Bimanual exam was done which revealed a retroverted uterus, and a uterus that was non-tender and normal size and consistency. Speculum placed in vagina and cervix well visualized. Cervix cleaned with betadine X3. Single tooth tenaculum placed on posterior face of cervix, gentle traction applied. Uterine sound @ 9 cm. Unable to pass Mirena IUD past 7cm into uterus. Tenaculum placed on anterior face of cervix and attempted placement of IUD, still unable to pass IUD beyond 7cm.  

Attempted Kyleena IUD and unable to pass Kyleena IUD beyond 7cm. Sounded again and sounded at 9cm. Dr. X called into the room for assistance. She placed Mirena IUD at 7cm and did transvaginal US. Confirmed lower uterine segment/cervical IUD placement and IUD was removed. Pt tolerated procedure well. Minimal bleeding at tenaculum site.

On failed attempts, I am never quite sure whether to bill the intrauterine device (IUD) code to insurance? And if we insert and remove at same appointment, would we bill 58300 with a modifier and 58301?

Texas Subscriber

Answer: Most likely, your insurer is not going to reimburse for the devices because they were removed, but you can go to the device company to see if they can help.

As for the procedure, you only have two options when a procedure fails: modifier 53 (Discontinued procedure) which pays usually about 10% of the fee and a modifier 52 (Reduced procedure) which may or may not be reduced by the payer.

Since the IUD was difficult to insert and could not be placed eventually despite help and ultrasound confirmation, you can only go with 58300-52 (Insertion of intrauterine device (IUD)). Essentially, you inserted and removed two IUDs. However, no payer is going to allow you to bill this as 58300 and 58301 (Removal of intrauterine device (IUD)) as the intent was not to remove one and insert a new one. Each failed.

Best bet: Therefore, you should report 58300-52 and the transvaginal ultrasound (76830, Ultrasound, transvaginal) and hope for the best.

You should not report modifier 22 (Increased procedural service) with 58300 despite the increased work, because modifiers 52 and 22 are mutually exclusive and the fact is the IUD was ultimately not placed. This is one of those weird cases that may not get you the reimbursement you deserve.