Ob-Gyn Coding Alert

Find out if your ob-gyn did a refitting at the time of a pessary insertion

If you think 57160 is all you need for pessary insertion procedures, think again. Not only will you have to consult your HCPCS and ICD-9 manuals, you must follow your practice's policy on whether the patient or you are responsible for the supplies. Pick Out Pertinent Pessary Dx A pessary is a -support device for pelvic-floor weakness, such as uterine prolapse, vaginal prolapse (enterocele, cystocele, rectocele), and stress urinary incontinence,- says Cindy Foley, billing manager at two ob-gyn practices in Syracuse, N.Y. The pessary device is the most common--and occasionally the only--nonsurgical option for treating advanced uterine prolapse.

Causes: Weakening of the muscles and ligaments that hold the uterus in place, which could be triggered by multiple vaginal deliveries, obesity, hormonal changes or old age, can cause the prolapse. Your most common ICD-9 codes to link to pessary devices are 618.0x (Prolapse of vaginal walls without mention of uterine prolapse), 618.1 (Uterine prolapse without mention of vaginal wall prolapse), or other 618.x, based on the degree of prolapse or when the patient has combined uterovaginal prolapse.
 
Keep in mind: You need the information for the fifth digit of the diagnosis, -which is a necessity,- Foley says. Make sure your ob-gyn provides the information in his notes.
 
With the prolapse codes, the fifth digit gives you a different diagnosis for each ICD-9 code. For instance, 618.0 is not a valid code. All of the codes in the 618.0x category have a fifth digit that signifies the specific condition--for example, 618.00 (Unspecified prolapse of vaginal walls), 618.01 (Cystocele, midline) and so on. The two code categories under 618 that require a fifth digit are 618.0x and 618.8x (Other specified genital prolapse). Use 57160 Initially, E/M for Reinsertion CPT provides you with only one code for pessary insertion: 57160 (Fitting and insertion of pessary or other intravaginal support device). This code has no global days.

Example 1: The patient presents for her yearly examination, and the ob-gyn decides to fit her with and insert a pessary during the same visit. You should still report 57160 in addition to the exam code (such as 99211-99215 or 99395-99397). Remember to add modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M or preventive service.

Example 2: A Medicare patient is eligible for her screening pelvic and breast exam, and during this visit the ob-gyn inserts a pessary. You should report the pessary insertion 57160 in addition to G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination).

Red flag: If the patient returns for the cleaning and reinsertion [...]