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Ob-Gyn Coding Alert

Reader Question:

Identify Modifiers in This IUD Removal/Insertion Scenario

Question: My physician removed an IUD hysteroscopically and reinserted a new device while in the OR. How should I bill this?

Washington Subscriber

Answer: You may have an uphill battle with this one. If the intrauterine device (IUD) was impacted in the uterine wall (and this must be documented), your code would be 58562 (Hysteroscopy, surgical; with removal of impacted foreign body) for the removal and then 58300 (Insertion of intrauterine device [IUD]) for the insertion.

If this was done with assistance of hysteroscopy to visualize the old one (as in the strings would not be identified) but it was not impacted, then 58555 (Hysteroscopy, diagnostic [separate procedure]) with 58301-51 (Removal of intrauterine device [IUD]; Multiple procedures) and 58300-51 will be your best bet.

Heads up: Recognize that some payers will not reimburse for both 58301 and 58300 at the same session, so you mighthave to go with 58301-22 (Increased procedural service) or 58301-59 (Distinct procedural service) for the removal with reinsertion. Check your payer code bundles to be sure.  

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