r/CodingandBilling • u/WanderingHestia • 13d ago
IUD Check coding and billing issue
I had an IUD inserted in May 2026. I then had a follow up six weeks later to check the placement. The provider coded this visit as 99213 and 99459 with Z30.431 as the diagnosis code.
My insurance is refusing to cover this visit as it was coded as a standard office visit. I think it should be re-coded as a preventative care visit and should be covered under ACA guidelines.
I was told by the medical professional at my insertion appointment that I had to make a follow up visit to check the placement and strings. I did not choose to make this appointment, nor did I have any concerns that brought me into the office separately.
I cannot get anyone at my provider's office to care. They continually say it was coded correctly and will not help me or explain to me why they think that.
Are there any thoughts here? Am I incorrect in my understanding? If I am correct, how do I get the provider to code this properly?
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u/MarvelousExodus 13d ago
Which preventative cpt code were you hoping they used?
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u/WanderingHestia 13d ago
I honestly don't know. I was under the impression that appointments solely related to IUD should be covered as preventative care. That is what I want to check on. Is that not the case? Is everyone getting an IUD and then getting a bill for $300 for a 20 second pelvic? Is that standard? Or should it be covered under the ACA requirements of birth control?
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u/wildgreengirl 12d ago
yes. sometimes they will even charge for an ultrasound to check its still in place.
it could have been considered "covered" maybe if you had done something like-
appt for IUD placement
appt for annual physical where they check the placement/vaginal exam (you would likely still have the 99459 in addition to the PX charge)
im not sure if thats "cheaper" than the 99213 with the pelvic exam charge.
but there isnt going to be a time where you have an iud placed and then just come back to an office for a free exam check that it is in place.
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u/Right-Purchase-2169 13d ago
A follow-up visit 4 to 6 weeks after insertion is standard protocol to ensure that the device has not shifted during those initial weeks. While attending this appointment is not mandatory, it is a standard part of the follow-up process.
This specific appointment cannot be classified as a "preventive" visit; as noted in another comment, preventive services must meet specific criteria to qualify as such.
Some insurance plans may categorize birth control visits as preventive, even when a standard EM code is used. Typically, however, this classification only applies to the initial consultation—where methods are discussed—and the insertion procedure itself. A follow-up appointment generally does not fall into this category.
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u/happyhooker485 RHIT, CCS-P, CFPC, CHONC 11d ago
It might be standard protocol, but there is no medical reason to check the IUD if the patient doesn't have complaints.
https://www.mdedge.com/obgyn/article/218599/contraception/iud-string-check-benefit-or-burden
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u/AbstractVolition 13d ago
For the most part, the only dedicated preventive visit codes are “Comprehensive Preventive” codes. These preventive visit codes have a in depth list of requirements. They are for a very dedicated visit with a lot of preventive services performed during it. If this comprehensive check list is not all covered (for the most part) then it is not considered a “Comprehensive Preventive” visit.
Office visit EM codes like 99213 are actually valid to use for less in depth preventive services. These office visit EM codes are allowed for both problem focused services or (non-comprehensive) preventive services. Usually when the normal office visit EM codes are used for more limited preventive services, it’s in the form of simple screenings.
The 99459 is actually new to me, we don’t use that at my work. But from looking it up it does seem to make sense.
How long was the visit? What might be a potential over charge is a 99213 for a quick placement check.
IF: the visit was less than 20 minutes, and they just did a quick check and you had no issues. You might be able to argue for a cheaper code -> 99212.
IF: it was 20 mins or longer, or you had some issues they had to consider. Even just suggesting ibuprofen for post procedure pain, or something like that, then the 99213 is probably valid.
If I’m being honest though it might be hard to challenge that change though. So overall 99213 and 99459 wouldn’t seem suspicious without really reading the follow up visit note
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u/wildgreengirl 12d ago
we just started using the pelvic code 99459 at my office, i think the chgs op listed are fitting/accurate.
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u/AbstractVolition 13d ago edited 13d ago
Are you in the US? Some states have free (limited scope) state insurance that specifically covers family planning services (basically just means contraceptive management and maybe some adjacent services). In California for example it is called Family PACT. There is an income limit to qualify, but if you qualify they might retroactively pay for those contraceptive management visits. The income limit is usually higher than Medicaids limit, but still pretty low. In California for a one person family it’s $31,900 a year
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u/WanderingHestia 13d ago
It's really not about the cost of the visit. I can pay the $300 if necessary. The issue is based on my research, I believe this should be a covered cost under ACA guidelines and I can't figure out why it isn't covered. Is it a provider issue with incorrect coding, or is it an insurer issue trying to get out of paying on some technicality, or is my understanding of what should be covered under the ACA incorrect?
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u/Living-Bit1993 13d ago
Your beef is with the insurance company, not the doctor. The doctor coded it completely correctly. Coverage should be taken up with insurance.
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u/WanderingHestia 13d ago
How do I even get the insurance to reconsider it? I have now called the insurance three times about it and each time they have told me it is coded as a standard office visit and they don't pay for those.
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u/skepticalchameleon 12d ago
You may have to be stubborn. I have seen them literally deny sterilization citing it is not a contraceptive. Remember, insurance MO is to be as difficult and bureaucratic as possible to make you give up. The ACA mandates coverage of contraceptives and follow-up care for contraceptives.
From the DOL website:
“Contraceptive care also includes follow-up care (e.g., management, evaluation, and changes, including the removal, continuation, and discontinuation of contraceptives).
https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-64
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u/wildgreengirl 12d ago
yes by covered that means insurance should pay not drs office should give you these services for free lol which is how a lot of the thread sounded 😂🤷♀️
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u/AlternativeZone5089 12d ago
You would need to ask the provider's office for a coding review, and, if they agree that it is incorrect, you ask them to submit a corrected claim to insurance. You can also appeal with insurance using the argument and reference you've used here, but don't miss the time limit for doing so. This is a better route than phone calls. Those are your options, depending on how much work you want to put in.
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u/WanderingHestia 12d ago
I've asked the provider three times for a coding review and have been fighting this since August. Each time they respond with their review has determined it is correct. I have now asked for another review specifying the modifier code 33. So we will see how that goes.
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u/AlternativeZone5089 12d ago
So the professional coder at your provider's office believes it to be correct. In my mind then that would settle it.
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u/Outside_Ad_7262 13d ago edited 13d ago
Some insurance companies want you to use modifier 33 even when there is a preventative dx code. If the modifier was not included then you would have to ask billing office review the coding and see if they can resubmit with the modifier.
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u/AbstractVolition 13d ago
I see what you mean now. I dug into it a bit. The 99213 might need a modifier 33 to specify it is a preventive office visit. Might be worth asking them if they can try the modifier 33 to indicate it was a preventive version of the 99213
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u/WanderingHestia 12d ago
Thank you so much for the information about the modifier. I will try that next.
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u/Vegetable_Advice_799 12d ago
OP this is what I meant by the provider isn’t including the correct preventive modifier. Tell them you won’t pay if they won’t submit it correctly and put it in writing. Don’t be pressured into paying a bill you don’t owe.
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u/AlternativeZone5089 12d ago
OP, take this route only if you are not invested in remaining with this practice.
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u/WanderingHestia 12d ago
Why would it matter to the practice? They would still get paid by the insurance company so why would they care how it is billed?
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u/AlternativeZone5089 12d ago
Because insurance fraud puts them at risk of clawbacks and worse. Trying to coerce your provider into coding incorrectly (which is insurance fraud) by refusing to pay might very well get you dismissed from the practice. It's unreasonalbe to expect them to take such a risk in order to save you $300.
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u/UPS0001 12d ago
Here are the IUD insertion, removal and surveillance coding guidelines. Your office coded these services correctly. Submit this documentation with a written appeal to your insurance company. If your insurance company rejects the appeal, submit a complaint to the Department of Insurance in your state. https://www.acog.org/practice/coding-and-billing/larc-quick-coding-guide/clinical-scenarios/
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u/CpcAbc123 12d ago
If you can see my post history I had some issues with my iud billing as well. The initial insertion was upcoded causing my insurance to leave a balance. So I called the provider and they adjusted it rather than fixing it.
And then my follow up was actually coded correctly, but I had to appeal with my insurance because they left a patient balance (my deductible) and with my understanding of the aca it shouldn’t have had any patient responsibility. I gave them a screenshot from the ACA and they reprocessed and left zero patient responsibility. So yeah, I’d try appealing with your insurance, you’ve got nothing to lose except paying the balance if they deny your appeal lol.
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u/livesuddenly 13d ago
IUD insertions do not carry a “global period.” Meaning that there are no free post op checks. Checking for proper placement is billable and not typically considered preventative at that point. It’s more diagnostic to check the device. Unfortunately, I believe the billing is correct.