Learn the ABCs (and Zs) of IUD Coding

IUD

Intrauterine devices (IUDs) for birth control are fairly common, but somehow the coding for IUD-related services isn’t as clear-cut as it could be. In today’s post, get to know the codes and a common coding hurdle to watch for.

Go Through All the Code Sets to Find the Codes

CPT® provides these codes for IUD services:

  • 58300 (Insertion of intrauterine device (IUD))
  • 58301 (Removal of intrauterine device (IUD)).

ICD-10-CM offers codes specific to IUD encounters, too:

  • Z30.430 (Encounter for insertion of intrauterine contraceptive device)
  • Z30.431 (Encounter for routine checking of intrauterine contraceptive device)
  • Z30.432 (Encounter for removal of intrauterine contraceptive device)
  • Z30.433 (Encounter for removal and reinsertion of intrauterine contraceptive device).

ICD-10-CM does like to dig into the details, of course, so you’ll find other codes, too, like these complication codes:

  • T83.31XA (Breakdown [mechanical] of intrauterine contraceptive device, initial encounter)
  • T83.32XA (Displacement of intrauterine contraceptive device, initial encounter)
  • T83.39XA (Other mechanical complication of intrauterine contraceptive device, initial encounter).

HCPCS has a handful of options for you, too, including an S code that certain payers (other than Medicare) may accept for the supply of the IUD:

  • J7297 (Levonorgestrel-releasing intrauterine contraceptive system (Liletta), 52 mg)
  • J7298 (Levonorgestrel-releasing intrauterine contraceptive system (Mirena), 52 mg)
  • J7300 (Intrauterine copper contraceptive)
  • J7301 (Levonorgestrel-releasing intrauterine contraceptive system (Skyla), 13.5 mg)
  • S4989 (Contraceptive intrauterine device (e.g., Progestacert IUD), including implants and supplies).

Watch for the Replacement Coding Roadblock

Comparing the CPT® codes to the ICD-10 codes reveals a hitch. ICD-10 makes it simple to report replacement using Z30.433 (removal and reinsertion). But CPT® has one code for removal (58301) and another for insertion (58300). So how do you report the CPT® codes during an encounter for replacement?

As long ago as April 1998, AMA’s CPT® Assistant said the removal of an IUD would be reported with one code and the insertion with another. That article may be old enough to vote by now, but it throws in a dose of reality that still holds true today: “Third-party payor reporting and reimbursement guidelines may vary.” And this is the issue coders have to deal with.

When you report both 58300 and 58301, many payers will pay you for only one of the codes, and often it’s the lower paying insertion code 58300 (2.06 nonfacility RVUs) instead of the higher paying removal code 58301 (2.69 nonfacility RVUs).

Experts advise getting your payers’ written policies to determine their view on correct coding. If no policy is available, watch to see which payers cover only one code when you report both. Then create an internal policy to be sure you’re coding all IUD replacement services consistently. For instance, you may choose to report only 58301 or even 58301-22 (Increased procedural services) to reflect the additional work of replacement.

For those payers that do accept both 58300 and 58301 for a replacement encounter, experts advise appending modifier 51 (Multiple procedures) to 58300 to identify the performance of multiple procedures at a single encounter (assuming the payer accepts modifier 51).

What About You?

How do you code IUD replacement? Do you code differently for different payers?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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