Pessary coding - Info from ACOG

ACOG recently put this out, and I felt it worthy to share... 

Coding and Billing for Pessaries


Two codes should be submitted on the 1500 claims form – one for the actual fitting and insertion of the pessary, and a second code for the pessary itself.

To report the initial fitting and insertion of the pessary or other intravaginal device, report CPT-4 code 57160. The supply of the new pessary may be reported separately with either HCPCS code A4561 (Pessary, rubber, any type) or A4562 (Pessary, non rubber, any type). In most cases, physicians are using non-rubber (silicone) pessaries and code A4562 should be reported. Please check with the vendor and/or package description if there is any question as to whether the pessary is rubber or non-rubber (silicone). Note: Non-Medicare carries may accept CPT code 99070 (Supplies and materials, provided by the physician over and above those usually included with the office visit or other services rendered) for the supply of the pessary instead of the HCPCS codes. Check with the payer before reporting.

According to CMS, pessaries can be provided to Medicare beneficiaries by properly enrolled Medicare Suppliers on the receipt of a valid prescription order from a physician. However, the beneficiary cannot "order" a Medicare-covered Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) item and then submit a claim to Medicare and expect reimbursement. The Medicare program pays the DMEPOS Supplier directly upon submission by the Supplier of a valid claim.

According to a CMS representative, “If the pharmacy that you are purchasing the pessary from participates with Medicare they should submit a claim for the patient to Medicare (local carriers) for the item. If the patient is going to a pharmacy that is not enrolled with Medicare the patient will not have a method of being reimbursed so it is best to make sure they are going to a pharmacy that is enrolled with Medicare”.

Coding for pessary removal:

If a patient comes into the office to have her pessary removed, cleansed, and reinserted, an appropriate evaluation and management code (99211-99215) should be reported, based on the key components performed (history, examination, and medical decision making), as this is considered part of the E/M service.

If a patient presents to your office for the removal of an impacted pessary, it is appropriate to report CPT-4 code 57415 (Removal of impacted vaginal foreign body under anesthesia). However, if this is performed without anesthesia, report an E/M code at the appropriate level instead. Report ICD-9 diagnosis code 996.39 (Mechanical complication of genitourinary, other) in addition to the patients other conditions such as 616.10 [Vaginitis], or 618.2-618.4 [Cystocele with uterine prolaspe].
You can also access this article from the ACOG website at http://www.acog.org/About_ACOG/ACOG_Departments/Coding_and_Nomenclature/Coding_and_Billing_for_Pessaries

Free ICD-10 Update Webinar for you!!! - Come Join me!!

Good Morning to all...  I have a FREE!!!  (yes, free)  webinar that I am doing in coordination with codingcert.com.  It's on the transition for ICD-10.  Take a moment to check it out, and sign up for this quick 30 minute session.  I'd love to have you join me.  May 2nd.  2012    Noon (Eastern)  11:00 (Central)  10:00 (Mountain)  9:00 (Pacific)

http://www.codingcert.com/news-resources/free-webinar-icd-10-status-update-whats-next-transition-training-strategies/

I hope to "hear" that you're there! 

AAPC 2012 Las Vegas Convention Highlights! & the ICD-10 proposed 1 year delay

Here's the scoop....Just a quick note to give you the highlights from the AAPC LasVegas Convention.  The convention was sold-out, and we had aprox. 2500 attendees!!!  WOW!!!  

The big topic at this year’s convention is Medical Necessity and thorough Documentation of Records. Another big issue has been the implementation of EHR/EMR (electronic health records/electronic medical records and the implications for coding compliance)  The best value of all from the conference is the networking and education you receive simply from interacting with coders of all types, specialties and regions throughout the USA.  I was so honored to attend, but also, to present two separate educational forums, AND get to attend classes myself to keep my educational & learning processes flowing!

• Medical Necessity:  Just a few weeks ago I posted an article on medical necessity.  This is something that all the insurance payers are looking at.  Unfortunately, it seems that medical necessity is being tied very closely to reimbursement by the payers.  So, this in-turn requires the physicians and providers of medical care to document much more clearly, concisely, and completely.

• Electronic Records: The EHR/EMR issue is also being scrutinized by many payers and independent auditors. They are looking very closely at records that could be construed as a cloned record, and pulled-forward or cut/paste record, or even records that have data that the physician can simply ‘click a box and add documentation to up-code, or substantiate a service.  In respect to these types of services, careful evaluation prior to a software EMR/EHR purchase is vital.

• Coding Ethics:  Coding, billing and documentation ethics was also a hot topic at convention this year.  As a coder that is credentialed by the AAPC and AHIMA, it is imperative that we continue to conduct ethical coding, auditing, and billing functions.  This truly means that we, as coders,  are charged with ensuring that the codes billed embody what was truly performed within the medical visit or procedure.

• AAPC Coding presentations: I had the amazing opportunity to present two separate sessions this year at the conference.   Both session that I presented (OB ultrasounds and the daVinci robotics)  were well attended.  I had over 200 people in each session….  I love doing this type of thing, as you really get the opportunity to meet with the attendee’s up close and personal.  The other benefit is getting to see those “light-bulb” moments when the coder really understands a new topic! 

Again, for all of my blog readers – I am available to help you and share the knowledge.  I should have a new post out soon on coding ethics, documentation and coding dilemmas within the next few weeks.  I’ll also be deep in developing CPT and ICD-9/ICD-10 curriculum for beginners, and working on my next webinar presentation for Codingcert.com.  I will be presenting on the topic of  ancillary services in OB/GYN (May 2012) I am also working with some terrific people at obgynhospitalist.com and developing a good coding resource location for our OB/GYN hospitalists. 

• ICD-10 delay:  As of 04/10/2012 CMS has proposed a 1 year delay on the implementation of ICD-10.  Below  are 2 links to review what is going on with this.  However, as Coders, we still need to keep forging forward, and learning all we can.  We want to be well prepared and ‘ready to go’ as soon as the implementation arrives.  I am disappointed that the payers have lobbied to have this delay implemented.  But… It is what it is……. 

HHS Press Release

http://www.hhs.gov/news/press/2012pres/04/20120409a.html

CMS Fact Sheet

http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4330&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

In conclusion – keep learning, keep growing, and keep sharing the coding knowledge.  If you don’t have an immediate coding solution or answer, you have the skills to know who to ask, or how to find out!!!    Happy Coding <3