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UCR 164: FAQs - Coding for insertion of an Estring; Trimix billing, what codes should you use?

September 29, 2023 

Ray, Mark, and Scott discuss questions that came into the Urology Coding and Reimbursement Group:

1. I'm trying to verify the correct CPT code for insertion of an Estring to treat vaginal chagnes in menopause. AAPC has two different answers, but they are almost 20 years apart! I'm looking at CPT 57160 and 57170. 57160 is insertion of pessary OR other intravaginal support device. 57170 is diaphragm or cervical cap fitting with instruction. In the AAPC post that is most recent (9/10/21) they said to use 57170 for the Estring. If 57170 is mostly to prevent pregnancy, I can't see how this would be appropriate for a woman in menopause.
2. Hello. I have a question regarding trimix billing. I know that there is not a HCPCS code since it is a compound drug. From my own research i have found conflicting information with some saying to bill each drug separately and others to bill unlisted J3490. In your opinion, what is the best practice for coding Trimix? Thank you!

Mark Painter and PRS Consulting

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