Ob-Gyn Coding Alert

Question: My ob-gyn did a laparoscopic removal and insertion of an intrauterine device (IUD) in the hospital setting. Should I report the insertion with 58300 and the removal with 58301? Are there any other codes I should report?

Tennessee Subscriber

Answer: You should report the removal of an IUD (through the cervix, which is the only accepted way of doing this service) with 58301 (Removal of intrauterine device [IUD]).

Ideally, you would be able to report the insertion with 58300 (Insertion of intrauterine device [IUD]) as well, and the American College of Obstetricians and Gynecologists (ACOG) has indicated that you can bill for both. But many payers continue to deny claims where you report codes for both the insertion (58300) and removal (58301) on the same day, despite no correct coding initiative (CCI) bundle preventing you from reporting this code combination.

What's worse is that payers often pay only the lesservalued code. Code 58300 has 2.07 relative value units (RVUs) while 58301 has 2.54. That means your practice is out 0.47 RVUs or approximately $17, which can add up. Tactic: You should limit your reimbursement losses by billing 58301, because this code pays more than the other.

Also, whether or not you can bill for the insertion of the IUD, you should bill for the new IUD that the ob-gyn placed (J7300, Intrauterine copper contraceptive or J7302, Levonorgestrel-releasing intrauterine contraceptive system, 52 mg).

Bigger issue: You say "laparoscopic" removal. You need to go back and read the op report, because an ob-gyn cannot insert an IUD via a laparoscope. If the IUD was floating in the abdominal cavity and the ob-gyn removed it via the laparoscope, then you should report 49329 (Unlisted laparoscopy procedure, abdomen, peritoneum and omentum). If the ob-gyn inserted the IUD via the vaginal canal afterward, then you would bill 58300, and you should receive reimbursement for both under this circumstance.