Reimbursement Advisor

If IUD insertion fails and payer balks, try the manufacturer

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Q How should I code a failed insertion of a Mirena IUD? The company advised us to use the modifier -53 for the supply and the procedure.

A In this situation, -53 (discontinued procedure) is not correct. The correct modifier for a failed procedure is -52 (reduced services), which should be added to the procedure code for the insertion (58300).

As for the supply, bill the payer for the IUD if an insertion attempt was made, because the attempt renders the supply unusable. In that case, it would be appropriate to add the modifier -52 to the supply code J7302. If the payer denies the claim for the supply, ask the manufacturer for a replacement or refund for the unusable IUD.

Discontinued service (modifier -53) can only be used when the procedure is discontinued due to a problem that threatened the well-being of the patient (such as increased or decreased blood pressure), and you must have carried out surgical prep and anesthesia induction.

Typically, IUD insertion fails because of cervical stenosis, and is coded 622.4 (stricture and stenosis of cervix)—unless another diagnosis explains the failed procedure.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

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