Wiki IUD insertion + Endo bio question

[jacquij07]

Pt comes in the office for IUD insertion. While prepping pt for procedure, Dr reviews pt's last ultrasound and discovers a 5mm endometrium on u/s. Dr decides to preform an endometrial biopsy plus the IUD insertion using paracervical block.
Should i code for 58100-59 (endo bio) 58300 (iud insert) 64435-51 (para block) and the mirena J7302?

Thanks!

 

[LargoFLSunshine]

58100, 58300-51 (Not 59 since they are not mutually exclusive and fall under multiple procedure guidelines)

Also, we have been advised that the paracervical block is included in the CPT code for the IUD insertion, so we do not bill separately.

Hope this helps!

Marcie S., CPC

 

[sueskuhn]

Ins not covering bx and IUD insertion

We billed the endometrial biopsy done at the same time as the IUD insertion. Our major carrier in our area is denying the biopsy. They are indicating it is a component of the overall procedure billed. We asked for a "clinical editing review" and that is the explanation.
The endo bx had a 51 modifier. My thought is that we should have used 59 as the modifier since it is a separate procedure. My interpretation of that is that the endo bx can be performed independently of the IUD insertion and vise versa.
I would love some input into this situation and if my thoughts are not correct, please share what makes sense.