Article - Billing and Coding: Treatment of Abnormal Uterine Bleeding with Intrauterine Device (Hormone-Eluting) (A59620)

CMS National Coverage PolicySocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.Article TextThis Billing and Coding Article contains coding and other guidelines that reflect proper billing for insertion of an Intrauterine Device (IUD) (Hormone-Eluting) for the treatment of abnormal uterine bleeding.Coding GuidanceChronic abnormal uterine bleeding (AUB) describes irregularities in the menstrual cycle involving frequency, regularity, duration, and volume of flow outside of pregnancy for at least six months. The following conditions causing AUB can be treated with levonorgestrel-releasing intrauterine device (Hormone-Eluting IUD) depending on the patient's desire for fertility, medical comorbidities, symptoms, and distortion of the uterine cavity: Leiomyomas (fibroids), malignancy or endometrial hyperplasia, and iatrogenic causes of AUB.Novitas is aware that the insertion of a progestin-containing IUD is an alternative method of managing endometrial hyperplasia for patients who wish to preserve fertility or are not surgical candidates. Novitas has determined that the use of a progestin-containing IUD may be approved for the use in the Medicare beneficiary with endometrial hyperplasia without atypia.Medicare does not allow payment for contraceptive devices or medication. For this reason, the service 58300, insertion of intrauterine device (IUD) has an "N" status in the Medicare Physician Fee Schedule, which means the service cannot be covered when billed to Medicare.The CPT code for IUD insertion (58300) will be auto-denied, therefore, providers should bill this service using CPT code 58999, unlisted procedure, female genital system (non-obstetrical), with an appropriate diagnosis for endometrial hyperplasia. Providers must also include the product description hormone IUD for endometrial hyperplasia in item 19 of the CMS-1500 form or electronic equivalent.The diagnosis code(s) must best describe the patient's condition for which the service was performed.Notice:It is not appropriate to bill Medicare for services that are not covered as if they are covered. When billing for non-covered services, use the appropriate modifier.Documentation RequirementsAll documentation must be maintained in the patient's medical record and made available to the contractor upon request.Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.The medical record must clearly document the specific clinical circumstances evidencing this medical necessity.