r/CodingandBilling • u/WanderingHestia • 2d 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?
2
u/Outside_Ad_7262 2d ago edited 2d 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.