The selection of ICD-10-CM diagnosis codes is based on the patient’s medical condition. Physicians must document patient diagnoses and procedures thoroughly and accurately. Common codes that may support medical necessity of a pessary include: CPT® Code Descriptor 57160 Fitting and insertion of pessary or other intravaginal support device
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.
Primary care practices, gynecology and urology practices often prescribe and provide pessaries. A pessary is used to treat pelvic organ prolapse and for urinary incontinence. It provides support for the vaginal walls or uterus.
A physician or non-physician practitioner (NPP) must first see the patient, take a history, examine the patient and decide if a pessary is the correct treatment. After that, the physician or NPP does the fitting, selects the correct pessary for the patient, and inserts it.
The pessary supply code (A4562) is also used if the patient is provided the pessary by the clinician at that visit.
If a pessary is fitted and supplied on the same day as the E/M service, bill CPT code 57160, “Fitting and insertion of pessary or other intravaginal support device,” and HCPCS code A4561, “Pessary, rubber, any type,” or A4562, “Pessary, nonrubber, any type,” and report the E/M service with modifier 25, “Significant, ...
Billing the DMERC The main reimbursement challenge for pessary coding lies with the DMERC a Medicare intermediary carrier that accepts billing for pessaries as well as other DME such as nebulizers wheelchairs and certain orthopedic devices.
Code 57160 may be reported a second time if the patient needs a re-fitting of a pessary, perhaps due to a significant weight change. But it is not used for routine cleaning. If the patient returns for a check up and the pessary is removed, cleaned, and reinserted, report only an evaluation and management service.
Physicians participating in Medicare may currently charge up to $44.16 for pessary insertions. Beneficiaries must pay 20% of this cost, or $8.83. Nonparticipating physicians may charge up to $48.24 for this procedure and beneficiaries are responsible for the full amount.
A pessary is fit to each individual by a physician's office, and is often covered by insurance. They are made of medical grade silicone, and can be worn for several days at a time if desired.
ICD-10 code N81. 3 for Complete uterovaginal prolapse is a medical classification as listed by WHO under the range - Diseases of the genitourinary system .
A pessary will be inserted by a medical professional, usually a gynecologist, in an initial fitting. They may need to try different styles and sizes to find the one that's right for you. Once you both feel the fitting is correct, they will give you training as to how to insert and clean the pessary by yourself.
57160According to ACOG, if a patient comes in for removal, cleansing and reinsertion you bill the appropriate E&M level. The only way you can bill 57160 would be if a NEW pessary was inserted.
Your doctor will perform a vaginal exam to see how severe your prolapse is. That'll help them decide if a pessary is a good option for you. If so, they can determine which type would be best. They'll take measurements and fit you for one in their office. It's important to get the right fit.
Z46. 89 - Encounter for fitting and adjustment of other specified devices | ICD-10-CM.
A pessary is used to treat pelvic organ prolapse and for urinary incontinence. It provides support for the vaginal walls or uterus. A physician or non-physician practitioner (NPP) must first see the patient, take a history, examine the patient and decide if a pessary is the correct treatment. After that, the physician or NPP does the fitting, selects the correct pessary for the patient, and inserts it. How should the medical practice bill for the service?
If both the evaluation, fitting and the insertion are done on the same calendar day, report both. Report the E/M service with modifier -25 and code 57160. The same diagnosis may be used for both services.
Do not report an additional E/M on the day patient returns for the fitting because the evaluation has already been done. One reason a patient may have to return for the insertion and sitting is because pre-authorization is required.
Code 57160 may be reported a second time if the patient needs a re-fitting of a pessary, perhaps due to a significant weight change. But it is not used for routine cleaning.
Although often both the evaluation and the fitting are done on the same day, there maybe circumstances in which the patient needs to return for the fitting and insertion. If the patient is evaluated and returns for the fitting and insertion on a subsequent day, report only the procedure code 57160 on the day the patient returns.