I would like to know how other coders bill for a Medicare patient who comes in for a pessary cleaning and reinsertion. My impression is the MCR guidelines state it needs to be billed as an E & M and not with the pessary insertion code. My physician was told at a conference by a coder that if the patient has a problem such as vaginitis you can bill for the office visit and the pessary insert code. Would just like information on how others would bill this visit.