Contraceptive Choices… What they are, how they work, how to Code for them
Contraception coding can be a challenge as coders are confronted with procedures that are new, and include devices in addition to the procedure code.
Let’s take a look at some of these options that are currently available for patients.
Occlusive devices used in contraception for women and men can be used to prevent pregnancy. These are devices that occlude the fallopian tubes or Vas deferen tubes and do not allow the egg or sperm to pass through the tube(s).
Let’s look at CPT code 58565 - Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants. This is a permanent form of birth control, and is NOT reversible. The physician performs the hysteroscopy, and places flexible spring-like inserts into the fallopian tube. (most commonly known as the “Essure device”. The very tip of the device remains outside the fallopian to which allows the physician to visually confirm placement of the device. The physician places one of the devices in each of the fallopian tubes. The body will then form scar-tissue around the device, blocking an egg from traveling through the fallopian tube. It usually takes approximately 3 months for the body to build up this scar tissue, which then your physician will confirm by performing a dye test,. and/or an ultrasound to ensure that both inserts are in place, and the tubes are completely blocked. There are no hormones involved in this type of procedure, so menstrual cycles will continue as normal.
Another procedure that is similar and can be used is CPT code 58615 Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach. In this procedure, a hysteroscopy is not utilized. This code should be used when a physician performs tubal occlusion without the use of the hysteroscope. A commonly used device with this procedure is the Filshie Clip. The Filshie clip device is placed around the tube/ It works by flattening and crushing the tube between the device, therefore preventing the egg from traveling through the tube. Some physicians also utilize a band/tie that works in nearly the same manner, by squeezing the tube tightly, and not allowing an egg to travel through the tube. This procedure is normally performed as outpatient surgery, but can be performed in an office surgical setting. This procedure is considered permanent, but some patients have had the clips removed, to try and achieve pregnancy.
There are no hormones involved in these type of procedures, so menstrual cycles will continue as normal. The diagnosis code to be used is code V25.2
Women now have a couple of different options regarding what is termed “implanted devices”. These are IUD’s and Contraceptive Capsule/rods.
“Implanon – Capsule Rods”
A new implantable device for contraception is known as the “Implanon” device. This is a small capsule/rod that is implanted subdermally and dispenses a long-acting hormone (etonogestrel) that provides up to 3 years of contraception. This is a reversible contraceptive measure. The hormone in the capsule does affect the menstrual cycle. This procedure(s) is normally performed in the office. In addition, HCPCS code: J7307 (Etonogestrel (contraceptive) implant system, including implant and supplies) should be billed in addition to the procedure code
Coders should keep in mind that CPT has a combination-code for removal & insert at the same time, so it is not appropriate to bill an insert code and a removal code in lieu of using the combination code. ICD-9 code V25.2 and v25.5 are the appropriate diagnosis code to be used
11981 Insertion, non-biodegradable drug delivery implant
11982 Removal, non-biodegradable drug delivery implant
11983 Removal, with reinsertion, non-biodegradable drug delivery implant
11975 Insertion, implantable contraceptive capsules
11976 Removal, implantable contraceptive capsules
11977 Removal, with reinsertion, implantable contraceptive capsules
IUD’s – Intra-Uterine Device
IUD’s work on the premise of implanting an “irritative” device within the uterus. These devices have been around since the 1970’s, and can be wrapped in copper, or contain hormone to prevent pregnancy. A copper wrapped device , such as a Paragard) can stay implanted in the Uterus up to 10 years. The copper on the device is toxic to sperm, therefore the uterus is an inhospitable environment for fertilization. The hormone containing device (such as a mirena) can be in place for up to 5 years, and works by making the mucus in the cervix thick and sticky, and keeps the lining of the uterus from becoming thick making the uterus inhospitable for fertilization. In addition, the hormones in the device also reduce menstrual bleeding and cramping. This is a reversible contraceptive. .
The CPT codes for IUD removal and insertion are:
58300 Insertion of intrauterine device (IUD)
58301 Removal of intrauterine device (IUD)
CPT does not have a “combination” code for the removal and re-insertion of an IUD. If a removal and re-insertion are performed on the same day, Coders are to bill for both codes and append a 51 modifier (multiple procedures performed at the same session) to the second procedure. These codes are not bundled in the CCI edits. In addition, you may need to add the HCPCS supply codes for the device in addition the the procedure.
ICD-9 codes V25.1 for insertion and then V25.42 should be used for the removal of the device.
J7300 Intrauterine Copper contraceptive (Paragard)
J7302 Levonorgestrel-releasing intrauterine device (Mirena)
Not all contraceptive procedures are performed on women. For men, a vasectomy can be performed. It is considered a permanent method of contraception. However, has been reversed with success. The vasectomy procedure prevents the release of sperm, therefore an egg cannot be fertilized. The procedure requires the physician to occlude, or cut the vas deferens from each testicle. The man continues to produce sperm, but they are reabsorbed by the body. This blockage of sperm does not interfere with the production of seminal fluid. Once the procedure is performed, a man will need follow up care to determine if the procedure was successful by submitting a semen or seminal fluid sample to the physician to check for a -0- sperm count. The traditional procedure utilizes a scalpel, however, there is a no-scalpel vas that uses a small clamp with pointed ends that punctures through the skin. In both procedures a clip, cautery, suture, or ligation is performed to complete the vasectomy.
The vasectomy procedure can be performed in an office or outpatient setting, and normally takes 20-30 minutes. The appropriate ICD-9 code for diagnosis is also V25.2
CPT codes for a vasectomy or vas procedure include:
55250 Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)
55450 Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate procedure)
Contraception and E&M
There are many, many more contraceptive choices that are prescribed by physicians Physicians or providers will do a thorough evaluation and management service (E&M)which can be coded from the New/Established patient codes 99201-99215 or the Preventive/Wellness codes 99381 – 99397. The provider should clearly document the contraceptive services rendered during the office visit to substantiate the contraceptive services or counseling provided. The diagnosis code should correspond to the service(s) provided. As a coder, review the V25 series of diagnosis-codes carefully when choosing the diagnosis for contraceptive management, and initiation of a contraceptive plan or procedure.
Cervical Cap or Diaphram
Over the counter contraceptives
Spermicidal Foam Sponge
Spermicidal Vaginal cream or suppository
Condoms (for male and/or female)
Many third party payers do not pay for contraceptive counseling/management or procedures for contraceptive management. In these cases, contact the carriers in advance to verify your patients’ insurance coverage. If coverage is not available or uncertain, be prepared to have the patient sign an ABN (Advanced Beneficiary Notice), and/or request payment in full at the time services are rendered.