by Lori-Lynne Webb, CPC, CCS-P, CCP, CHDA
Coding for the insertion and removal of intrauterine devices (IUD) and contraceptives has its own set of unique challenges. When coding for these procedures, coders must capture the following to accurately denote all relevant information:
To complicate matters, many insurance carriers don’t pay for contraceptive management services.
The V code section of the ICD-9 Manual outlines many different types of contraceptive management options. It may be difficult for coders to report IUDs, implantable contraceptives, hormone pills, patches, and rings when they don’t have a solid understanding of the products and how physicians use them.
IUDs date back to the early 1900s; however, usage was not really widespread until the 1970s. Currently, there are two types of IUDs on the market. One contains and releases the synthetic hormone Levonorgestrel, commonly known as the brand name Mirena®. The other IUD is known as the brand name ParaGard® T 380A. This IUD does not contain any hormone. Coders must know which type of IUD the healthcare provider inserts so they can accurately report the appropriate HCPCS supply code on the claim.
Consider the following two HCPCS codes for IUDs:
Both types of IUDs require a physician or appropriately trained physician assistant or nurse practitioner to insert the device. Both IUDs are T-shaped and have threads attached at the stem end of the ‘T.’ The healthcare provider grasps these threads when it is time to remove the device. The Mirena can be left in the uterus for as long as five years; the ParaGard T 380A can be left in the uterus for seven to 10 years.
To insert an IUD, physicians or other providers must place a speculum into the patient’s vagina to view the cervix. The provider then uses a tenaculum to gently pull down the cervix. Next, the provider dilates the cervix and guides the IUD into the uterus through an insertion tube placed in the cervix. Access a sample case study for coding the insertion of an IUD.
To report IUD insertion, assign the following codes:
To remove an IUD, the healthcare provider uses a device, such as forceps or clamps, to grasp and take out the IUD, via the aforementioned strings located at the base or stem of the device.
Report the following codes for IUD removal:
Although some CPT codes are combination codes (e.g., code 11983 for a subcutaneous drug delivery implant removed and reinserted at the same time) the CPT Manual does not include a code that represents both an IUD insertion and an IUD removal performed on the same day. When a physician performs both of these procedures on the same day, coders must report codes 58300 and 58301. Append modifier -51 to code 58301. The physician documentation and the diagnoses reported for each service on the insurance claim should support the reasons for the removal and re-insertion of the IUD during the same procedural setting.
Coders must also report the correct diagnosis codes to denote with IUD insertion and/or removal. For the insertion of the IUD, report one of the following V codes (Note that these are the only codes that denote insertion of an IUD):
In addition to V25.42, the following codes are commonly used to denote removal of an IUD (Note, this is not a comprehensive list):
IUDs require minimal—yet ongoing—oversight. When patients experience active symptoms due to the IUD (e.g., excessive bleeding, cramping, or pelvic inflammatory disease) or need routine IUD surveillance, report E/M codes for those visits as well as the diagnoses codes for IUD surveillance (V25.42), current GYN symptoms, or current GYN disease processes.
Some physicians also use ultrasound to confirm appropriate placement of an IUD at the time of insertion. When the healthcare provider performs this service, it is not bundled with the insertion codes. Consider the following possible codes for the placement confirmation:
Editor’s note: Lori-Lynne Webb, CPC, CCS-P, CCP, is an independent consultant in Melba, ID. E-mail her at LORIWEBB@sarmc.org.