Ob-Gyn Coding Alert

Question: The patient came in for a well woman exam. During this visit, the ob-gyn removed her intrauterine device (IUD). The insurance company denied the preventive code, because they say the IUD removal includes the preventive visit. Should I appeal with modifier 25? I thought this modifier only applies to E/M codes. Can you apply this modifier to a preventive code?

Texas Subscriber

Answer: Yes. The IUD removal is a procedure, and you can apply modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to any E/M (problem or preventive) code. Your ob-gyn should receive reimbursement for both services. 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]).

You'll report the well woman exam (WWE) using preventive visit codes (99381-99397) with modifier 25 appended.

Keep in mind: You may encounter payers who will deny the visit or WWE when the ob-gyn performs a procedure on the same date -- even with this modifier. Sometimes you only get paid for one. You must know your payer rules.