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Posted By sonia coder on 04-10-2018, 13:22:49 in Ob-Gyn
HI Melanie-- how would you bill this? On failed attempts I am never quite sure whether to bill the IUD code to insurance? And if we insert & remove at same appt would we bill 58300,modifier AND 58301? Thanks so much!

Pt presents today for placement of Mirena IUD. Risk, benefits and alternatives to Mirena IUD discussed with pt and informed consent obtained. Bimanual exam was done which revealed an retroverted uterus, and a uterus that was non-tender and normal size and consistency. Speculum placed in vagina and cervix well visualized. Cervix cleaned with betadine X3. Single tooth tenaculum placed on posterior face of cervix, gentle traction applied. Uterine sound @ 9 cm. Unable to pass Mirena IUD pass 7cm into uterus. Tenaculum placed on anterior face of cervix and attempted placement of IUD, still unable to pass IUD beyound 7cm.
Attempted Kyleena IUD and unable to pass Kyleena IUD beyound 7cm. Sounded again and sounded at 9cm. Dr. X called into the room for assistance. She placed Mirena IUD at 7cm and did transvaginal US. Confirmed lower uterine segment/cervical IUD placement and IUD was removed. Pt tolerated procedure well. Minimal bleeding at tenaculum site.
Comments (5)
Posted By sonia p on 04-13-2018, 09:11:55
Thank you again!
Posted By sonia p on 04-13-2018, 09:11:32
Thank you again!
Posted By Melanie Witt on 04-12-2018, 18:37:40
In my opinion, the insurer is not going to reimburse for the devices since they were removed, but yes, go to the device company to see if they can help.
Posted By sonia p on 04-12-2018, 09:04:49
Thank you so much. I had wondered about the 22 mod as well so thank you for addressing.
How about the devices - can we try to bill insurance for either of those? Or are they cases we just try to get reimbursed by the manufacturer?
Thanks again!
Posted By Melanie Witt on 04-11-2018, 18:57:54
You only have 2 options when a procedure fails: modifier -53 which pays usually about 10% of the fee and a modifier -52 which may or may not be reduced by the payer. Since the IUD was difficult to insert and could not be placed eventually despite help and ultrasound confirmation you can only go with 58300-52. Essentially you inserted and removed 2 IUDs but no payer is going to allow you to bill this as 58300 and 58301 as the intent was not to remove one and insert a new one - each failed. So I would just go with 58300-52 and the TVUS and hope for the best. A modifier -22 could not be reported with 58300 despite the increased work because -52 and -22 are mutually exclusive and the fact is the IUD was ultimately not placed. This is one of those weird cases that may not get you the reimbursement you deserve.
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