Ob-Gyn Coding Alert

" Coders of every medical specialty report difficulty in obtaining adequate, ethical  reimbursement for supplies. For ob/gyn practices, dispensing items such as pessaries, injectable drugs and contraceptive devices often means a low return for the time and money invested. Unfortunately, submitting the correct codes is only half the battle. Practices must often shift more of the financial burden to the patient to reach a break-even point with supplies.
Pessaries
 
A pessary is a silicone or rubber ring worn in the vagina to support a displaced or prolapsed vagina or uterus or to control urinary incontinence. The patient is measured and fitted for the pessary, and it is inserted in an in-office procedure. Code 57160* (fitting and insertion of pessary or other intravaginal support device) is billed to the carrier. The patient returns periodically for pessary cleaning and reinsertion, for which an E/M service is billed.
 
The HCPCS codes for the pessary supply are A4561 (pessary, rubber, any type) and A4562 (pessary, nonrubber, any type). A4562 is the more frequently used code as most physicians now dispense silicone pessaries to their patients because these incur fewer allergic reactions than rubber.
  
There are a number of ways to handle the pessary supply, depending on local-payer policy and the amount of overhead the practice wishes to assume. For non-Medicare patients, the practice can opt to keep a supply of pessaries on hand, which they essentially sell"" to the patient at the time of delivery.
 
Another option for non-Medicare patients is to write a prescription for the pessary" which the patient can have filled at a pharmacy or a medical-supply store. The patient then returns to the practice with the pessary and it is inserted. Practices that follow this method can't charge separately for the follow-up visit when the pessary is inserted. That service is part of the service included in 57160.
 
Medicare patients can also have their pessary prescription filled by an outside source and return to the practice for insertion. The patient then submits the claim directly to the Part B carrier. Note that this is a change of policy effective Jan. 1 2002. A recent CMS program memo instructs that pessaries are to be billed to the local Part B carrier rather than the Durable Medical Equipment Regional Carrier (DMERC) as has been customary until now. This is for claims with service dates on or after Jan. 1 only. Any refiling for an earlier service date would have to be done to the DMERC.

For claims before Jan. 1 2002 the patient submits the claim for the supply directly to the DMERC. However in DMERC Region D (Alaska American Samoa Arizona California Guam Hawaii Idaho Iowa Kansas Mariana Islands Missouri Montana Nebraska Nevada [...]