Urology Coding Alert

Question: How should I code for insertion of an E-string? A urologist of ours is going to be doing this for vaginal atrophy and such. But, there is almost no information online about this, and the manufacturing company was no help.

South Carolina Subscriber

Answer: There is no procedure code for the insertion. You should report the procedure as an E/M service at the appropriate level based on the documentation in the medical record (i.e., history and/or examination and medical decision-making) and code the supply as 99070 (Supplies and materials [except spectacles], provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided).

An E-string is a vaginal ring with a whitish core containing a drug reservoir of 2 mg estradiol. It is inserted high into the patient’s vagina. Once in place, it begins to release estradiol in a low, continuous dose for 90 days.

“This is a ring that can be self-administered (i.e., put in by the patient) and does not require physician insertion,” explains Melanie Witt, RN, CPC, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M. “Therefore there is no E/M code, and this does not qualify as a vaginal support device or a cervical caps so codes 57160 (Fitting and insertion of pessary or other intravaginal support device) and 57170 (Diaphragm or cervical cap fitting with instructions) cannot be reported either. This is reported as an E/M service only and the ring is billed using the NDC number: NDC 54868-5538-0.”

Caveat: This service may or may not be paid for by a third-party payer. If the procedure is not covered, the E/M service to insert the ring may also not be covered. Always check with your payer. Non-covered services should be billed to the patient. In these cases, you can have the patients sign an advanced beneficiary notice (ABN) indicating that she will accept financial responsibility if payment is denied by the payer.