Medical Billing Strategy for Pessary Coding

Medical Billing Strategy for Pessary Coding

Now is the time to fully understand Pessary coding. Pessary placement is becoming more and more common. When doing medical billing for this type of service it is important to know who supplied the device and when the procedure was performed.

A Pessary is a device used to correct pelvic floor weakness. It is used during uterine prolapses and urinary incontinence. This device is a perfect non surgical method to treat uterus prolapse. Not only is it cheaper for insurance carriers, but also better for the patient and physician. Although medical billing reimbursement will be less, so will the costs of performing the procedure.

Coming up with a correct medical billing diagnosis is key. The most common diagnosis codes to use are 618.1 (Uterine prolapse without mention of vaginal wall prolapse) and 618.0x (prolapse of vaginal walls without mention of uterine prolapse). When using these two codes in medical billing it is necessary to have a fifth digit. The fifth digit gives extra information about the diagnosis. Failure to use a fifth digit will get your medical billing claims denied.

Another key element when doing medical billing for Pessary insertion is the evaluation and management portion. If the patient comes in for a yearly physical exam and your physician decides a Pessary fitting is needed, he/she should bill an evaluation and management exam along with 57160 (Fitting and insertion of Pessary or other intravaginal support device). When using this medical billing method it is important to use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

Not only make sure your medical billing staff members understand how to build for Pessary insertions, but also make sure the physicians are aware of the slight differences as well. A well educated practice means accurate medical billing reimbursement.

View all Articles by: Melissa Clark, CCS-P