Ob-Gyn Coding Alert

You Be the Coder: 58565, V25.2: Navigate this Medicare Essure Procedure Scenario

- Published on Wed, Feb 09, 2011

Question: One of our ob-gyns did an Essure procedure on a Medicare patient for recurrent situational anxiety of pregnancy. What ICD-9 code should I report?

Answer: Medicare does not pay for sterilization under this condition. You should consider this service (58565, Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants) as an elective procedure. You should always list V25.2 (Sterilization) as the primary diagnosis, but you can list her mental condition secondary (for instance, 300.02, Generalized anxiety disorder).

ABN: Your provider should have the patient sign an advance beneficiary notice (ABN) acknowledging she agrees to have the service performed and will be responsible if not covered by Medicare. Report the services to Medicare with the GA modifier (Waiver of liability statement on file) appended to the CPT codes indicating that the provider has a signed ABN form on file for this service. If the service is [...]

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