tci Part B Insider - 2011 Issue 9

Reader Question: 58565 for Medicare Patient? Don't Expect Payment

Question: One of our ob-gyns did an Essure procedure on a Medicare patient for recurrent situational anxiety of pregnancy. What ICD-9 code should I report?Answer: Medicare does not pay for sterilization under this condition. You should consider this service (58565, Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants) as an elective procedure. You should always list V25.2 (Sterilization) as the primary diagnosis, but you can list her mental condition secondary (for instance, 300.02, Generalized anxiety disorder).ABN: Your provider should have the patient sign an advance beneficiary notice (ABN)...

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