Question: My ob-gyn tried to place an IUD, but the patient had a stenotic cervix. The physician could not place the device. What modifier should I use?
Answer: The answer depends on whose advice your payer follows.
According to the American Academy of Obstetricians and Gynecologists (ACOG), you should report 58300 (Insertion of intrauterine device [IUD]) and attach modifier 53 (Discontinued service). The ob-gyn started but discontinued the service, and your practice should be able to receive partial payment for this work.
Opponents of this method point out that CPT’s definition of modifier 53 states, “due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued.” CPT’s definition indicates that the physician must also have performed the surgical prep and anesthesia induction prior to discontinuing the procedure. Note that not every patient requires a local anesthetic for the IUD insertion. Also, CPT Assistant December 1996 explains you should use modifier 53 when a patient experiences an unexpected response or life-threatening condition that causes the procedure to be terminated (such as the patient fainting or developing an arrhythmia). In other words, you shouldn’t append modifier 53 to report elective cancellation.
So what’s your alternative? Suppose your ob-gyn had applied a local anesthetic to the cervix prior to the insertion. If the ob-gyn could not place the IUD because the patient has a stenotic cervix, you should consider this a failed procedure. Therefore, experts say you should use modifier 52 (Reduced services).
Click here to see the agenda for the Ob-Gyn Specialty Coding & Billing Conference in Orlando.
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