Ob-Gyn Coding Alert

Question: Recently, we have noticed our payers aren't paying us for pessary insertions. We bill a modifier 25 on the level visit, the pessary insertion fee, and the pessary fee. Payers are lumping the insertion fee into the office visit, which they pay. Is this something new?

Missouri Subscriber

Answer: No. This payer is simply trying to pay out less. In that case, have the patient come back for the pessary insertion. Having her come back makes sense anyway because the patient should be given the opportunity to think about whether she still wants the pessary or intrauterine device (IUD) after she's listened to these options.

In other words, if your ob-gyn is evaluating the patient or giving her options for either the pessary or the IUD, have her come back for the fitting and insertion of the pessary or the insertion of the IUD. If your office has scheduled the patient to have one put it in (and that is all), you should be billing for only the insertion (57160, Fitting and insertion of pessary or other intravaginal support device). This code includes both fitting and insertion.

Heads up: If you are fitting at one visit and then inserting at the next visit, you should still only bill 57160 once.