Ob-Gyn Coding Alert

Question: The ob-gyn was set to remove an intrauterine device (IUD) from a patient desiring future pregnancy. However, the patient could not tolerate the procedure, so she came back and had both a paracervical block and ultrasound guidance. The ob-gyn successfully removed the IUD this time. Can I submit 58301 with modifier 23? Should I use diagnosis code V65.5? South Carolina Subscriber Answer: You should report 58301 (Removal of intrauterine device [IUD]) appended with modifier 47 (Anesthesia by surgeon). Keep your fingers crossed, because you will most likely need to appeal your claim. Note: You should not use modifier 23 (Unusual anesthesia) because to use it, the physician must have given the patient a general anesthetic. As for the diagnosis code, you may try V47.9 (Unspecified problems with internal organs). If she is having problems with the removal, what was she like for the insertion? What code did you use that time? Watch out: You should not use V65.5 (Feared illness) because the patient's pain is real. The pain codes (338), however, don't fit this scenario either. -- The answers for Reader Questions and You Be the Coder provided by Melanie Witt, RN, CPC-OBGYN, MA, an ob-gyn coding expert based in Guadalupita, N.M.