Urology Coding Alert

Answer: The local gynecologist is correctly coding for when she re-inserts a pessary. If the patient returns for the cleaning and reinsertion of the pessary, you should report the E/M code, depending on the examination and medical decision-making your physician documents in the chart. You would not include 57160 (Fitting and insertion of pessary or other intravaginal support device) on your claim. The E/M service includes the cleaning and reinsertion.

The only way you could report 57160 again would be if the doctor fitted and inserted a new pessary. Sometimes the physician feels that he did a refitting at the time of the reinsertion and may feel justified to report 57160 again, but unless the physician refits a new pessary, you can only bill an E/M service, not 57160.

Bottom line: Before coding, find out if your urologist is doing an initial fitting and insertion or just a cleaning and reinsertion without a fitting. In your case, just billing the E/M code would seem to be the appropriate coding. Remember there must be a fitting to report code 57160, and even though this code has no global days, unless your doc is re-fitting, you should avoid 57160.