Urology Coding Alert

Question: We are looking for clarity regarding an insertion of a pessary, which we normally code with 57160. Can we only bill for the initial insertion? Or can we also code when we remove it for hygienic reasons and reinsert it?

Delaware Subscriber

Answer: You should report 57160 (Fitting and insertion of pessary or other intravaginal support device) for the initial insertion of a pessary. Remember by definition of CPT^® code 51760, this includes fitting for proper choice of the pessary size needed. If the patient comes back for the cleaning and reinsertion of the same pessary, you should report the appropriate E/M code for an established patient (99211-99215,  Office or other outpatient visit for the evaluation and management of an established patient...), depending on the examination and medical decision-making your physician documents in the chart. Do not include 57160 with this claim unless the physician refits and inserts a "new" pessary. Code 57160's description states that it includes the fitting of the pessary.

Take note: Medicare considers pessaries both a supply and an orthotic. You should report them as a supply provided by your office to the patient using the following HCPCS codes for Medicare Part B or private carriers on the standard CMS-1500 form:

• A4561 – Pessary, rubber, any type
• A4562- Pessary, nonrubber, any type.

Basically, the definition of a pessary is a specific support device to aid in correcting weaknesses of the pelvic floor, such as in a female patient with stress urinary incontinence and uterine or vaginal prolapse. In these situations, a pessary device is often the only way the patient can be improved and the prolapse corrected without surgery.