Urology Coding Alert

Question: We are looking for clarity regarding an insertion of a pessary, which is CPT 57160 . Can we only bill for the initial insertion? How about when we remove it for hygiene and reinsert it? Plus, what qualifies as a pessary?


Alabama Subscriber

Answer: You should report 57160 (Fitting and insertion of pessary or other intravaginal support device) for the initial insertion of a pessary. If the patient comes back for the cleaning and reinsertion of the 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. You should not include 57160. The only way you can report 57160 again is if your physician refits and inserts a new pessary. Code 57160's description states that it includes the fitting of the pessary.

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:

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.