Ob-Gyn Coding Alert

Question: Could you please give me the correct codes to bill a Medicare patient who comes in to have a pessary inserted, or cleaned and reinserted? Also, how do we bill the pessary insertion when the patient comes in for a yearly exam and also has the pessary insertion at that visit?

OCA Subscriber

Answer: The code for the initial pessary insertion is 57160. When the patient returns to have the pessary cleaned and reinserted, you bill only for an E/M service. The level of that service will be determined by the exam and medical decision-making documented in the chart at the time of the encounter. If the patient comes in for her yearly exam, and at that time also has a pessary fitted and inserted, the code 57160 would still be used. If this was also the year the patient was eligible for her screening pelvic and breast exam under Medicare guidelines, you would also bill for that screening exam using HCPCS code G0101.