Ob-Gyn Coding Alert

Question: I have trouble getting paid for the pessary and for the insertion. What are the proper codes?

May Decanay
Office of John B. Decanay, MD,
River Forest, IL

Answer: A pessary is a device worn in the vagina to support a displaced or prolapsed vagina or uterus. The proper supply code for the pessary is A4560 if you are billing Medicare, and the insertion code is 57160* (fitting and insertion of pessary or other intravaginal support device). The asterisk after the code indicates that this service includes the surgical procedure only per CPT rules (Medicare has assigned the code 0 global days). The ICD-9-CM diagnostic codes are for genital prolapse, depending on the circumstances. For vaginal prolapse without mention of uterine prolapse, the appropriate code is 618.0. For uterine prolapse without mention of vaginal wall prolapse, the code is 618.1. Other codes within the 618. family apply depending on the degree of prolapse, or a combined uterovaginal prolapse.

To be reimbursed for the pessary, you must have a supplier number. This supplier number is obtained from the National Supplier Clearinghouse. If you do not have a supplier number, you may not send a claim into Medicare and you may also not sell the pessary to the patient per Medicare rules. You may, however, right a prescription for the Pessary and bill Medicare for the insertion only. If you have a supplier number, you will send your claim to the Medicare Durable Equipment Regional Supplier (DMERC) and use the supply code A4560.

For follow-up care for refitting, cleaning and reinsertion, you will bill the appropriate level of E/M code.