LCD Reference Article Billing and Coding Article

Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999

A58649

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD.

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General Information

Source Article ID
N/A
Article ID
A58649
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999
Article Type
Billing and Coding
Original Effective Date
03/04/2021
Revision Effective Date
N/A
Revision Ending Date
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Retirement Date
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Article Guidance

Article Text

This article contains coding and other guidelines that reflect proper billing for insertion of an IUD (Hormone-Eluting) for Endometrial Hyperplasia.- CPT Code 58999.

Coding Information:
The diagnosis code(s) must best describe the patient's condition for which the service was performed.

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.

National Government Services (NGS) is aware that insertion of a progestin-containing intrauterine device (IUD) is an alternative method of managing endometrial hyperplasia in patients who are not reasonable surgical candidates or who wish to preserve fertility. NGS has determined that the use of a progestin containing IUD may be approved for use in the Medicare beneficiary who presents with endometrial hyperplasia without atypia.

Since the CPT code for IUD insertion will be auto-denied, providers should bill this service using CPT 58999 and an appropriate diagnosis for endometrial hyperplasia, including the product description "hormone IUD for endometrial hyperplasia" in Item 19 of the CMS-1500 form or the electronic equivalent.

Coding Information:
The diagnosis code(s) must best describe the patient's condition for which the service was performed.

Documentation

The medical record must clearly document the specific clinical circumstances evidencing this medical necessity.


Response To Comments

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Coding Information

Bill Type Codes

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CPT/HCPCS Modifiers

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ICD-10-CM Codes that Support Medical Necessity

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(2 Codes)
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Group 1 Codes
Code Description
N85.00 Endometrial hyperplasia, unspecified
N85.01 Benign endometrial hyperplasia
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
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Revision History Information

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
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SAD Process URL 2
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Public Versions
Updated On Effective Dates Status
02/25/2021 03/04/2021 - N/A Currently in Effect You are here

Keywords

  • IUD
  • Hormone-Eluting
  • Endometrial
  • Hyperplasia
  • 58999