Coding for Pessary Services
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. How should the medical practice bill for the service?
Evaluation, Fitting and Insertion on the Same Day:
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.
What if the Patient is Evaluated and Returns for the Fitting and Insertion on a Separate Visit?
Although often both the evaluation and the fitting are done on the same day, there may be 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. 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.
Billing for the Pessary Itself:
Bill in addition for the pessary itself if it is provided by the practice. There are two durable medical equipment codes for a pessary. A4561 is for a rubber pessary and A4562 is for a non-rubber pessary.
Pessary Re-fitting with Code 57160:
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. This will typically be an established patient office visit.
Pessary Insertion CPT® Codes:
57160 – Fitting and insertion of pessary or other intravaginal support device
A4561 – Pessary, rubber, any type
A4562 – Pessary, non rubber, any time
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