Clarifying IUD Coding. What you need to know
Understand payer policies on removals, use accurate codes, and know when to report both IUD services and E/M visits with modifier 25 to avoid IUD claim denials.
OB/GYN Medical Billing & Coding Alert
Understand the reasons why certain payers deny payment for removals.
Many coders express frustration with coding intrauterine device (IUD) claims due to the significant variation in payer policies. For example, some payers will cover IUD insertions but not removals, while others include removals as part of office visits.
To avoid denials and missed reimbursement opportunities, ask these three key questions. Review the coding guidelines from the American College of Obstetricians and Gynecologists (ACOG) and clarify any uncertainties with your payers.
What Should I Report When an Ob/gyn Inserts or Removes an IUD?
When your ob/gyn inserts an IUD, use code 58300 (Insertion of the intrauterine device [IUD]) along with Z30.430 (Encounter for insertion of the intrauterine contraceptive device).
For IUD removals, report code 58301 (Removal of intrauterine device [IUD]). If the removal is routine, link this code with Z30.432 (Encounter for removal of intrauterine contraceptive device).
If the removal is due to a complication, refer to your documentation for appropriate complication codes. Some examples include:
- T83.31XA (Breakdown [mechanical] of the intrauterine contraceptive device, initial encounter)
- T83.32XA (Displacement of the intrauterine contraceptive device, initial encounter)
- T83.39XA (Other mechanical complication of the intrauterine contraceptive device, initial encounter)
Should You Consider IUD Replacements as Both Insertion and Removal?
It depends.
According to ACOG, IUD replacements should be considered both an insertion and a removal. ACOG’s “Long-Acting Reversible Contraception Quick Coding Guide” and CPT Assistant support this.
However, be aware that payer policies may vary.
Many payers continue to deny claims when both the insertion (58300) and removal (58301) codes are reported on the same day, even though there is no National Correct Coding Initiative (NCCI) bundle preventing this combination. Very few payers (if any) will reimburse for both services on the same day.
In some cases, payers will only pay for the lesser-valued code. Code 58300 has 3.31 relative value units (RVUs), while 58301 has 3.33 RVUs, resulting in a loss of 0.02 RVUs, which can add up.
Tactic: Track the payers who only reimburse for insertion when both codes are billed during reinsertion and bill only the removal (58301) to those specific payers.
My Ob-Gyn Either Inserts or Removes an IUD at the Same Time as an E/M or Preventive Visit. Can I Report Both?
Yes, you can report both, as long as your ob-gyn’s documentation supports it by using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Ensure the physician’s notes are complete, as you'll likely need to appeal the claim.
If the visit is preventive, such as during an annual exam when the IUD insertion or removal is performed, add modifier 25 to the preventive services code (99381-99397). In theory, this should allow reimbursement for both the IUD insertion or removal and the preventive service.
This also applies to new or established patient office visit evaluation and management (E/M) codes like 99202-99215 (Office or other outpatient visits). For example, if the patient complains of pain and the OB/GYN discovers that the IUD is the cause and removes it, and if properly documented, you can report both 58301 (IUD removal) and the E/M service (99202-99215) with modifier 25.
In a 2016 publication, Humana noted that “Insertion and removal of an intrauterine device (IUD) is reimbursable with a new or established family planning visit or an evaluation and management visit. However, all components of an evaluation and management visit must be met and documented, in addition to the IUD service, before the IUD service can be reimbursed.”
Caution: While this is generally true, some payers may not reimburse for IUD removals and may prefer that you only submit the E/M service.
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