Ob-Gyn Coding Alert

These are nonphysician procedures that highly specialized clinical laboratories perform, Tropin says. If a physician provides services at the same time, you may report them also.
 
"These new and revised codes will assist us to code more specifically for services rendered, as well as facilitate negotiations with our payers," says Marie Mulhall, LPN, CPC, director of coding at Women's Health Connecticut in Avon.
 
When creating this new section, CPT deleted 89252 (Assisted oocyte fertilization, microtechnique [any method]) and 89256 (Preparation of cryopreserved embryos for transfer [includes thaw]) and renumbered them to 89280/89281 or 89352, respectively.
 
In addition, CPT 2004 includes two new Category III codes (0058T, Cryopreservation of reproductive tissue, ovarian; and 0059T, Cryopreservation of oocyte[s]) for tissue and oocyte cryopreservation procedures. If the ob-gyn performs a procedure that matches one of the new Category III codes, you should report it, rather than an unlisted-service code.
 
The other new and revised codes are as follows:

89250 - Culture of oocyte(s)/embryo(s), less than 4  days

89251 - ... with co-culture of oocyte(s)/embryos
 
Note: Code 89250 now allows you to report the culture of immature oocytes. Fertilization is no longer part of this code, and you should report it separately. You should also separately submit insemination, which was considered part of 89250 in CPT 2003. Code 89251 represents the additional work of microfertilization of more than 10 oocytes.

89258 - Cryopreservation; embryo(s)
89268 - Insemination of oocytes
89272 - Extended culture of oocyte(s)/embryo(s), 4-7 days
Note: You can bill 89272 with 89250 and 89251 because it represents a separate technique.

89280 - Assisted oocyte fertilization, microtechnique; less than or equal to 10 oocytes
89281 - ... greater than 10 oocytes
89290 - Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis); less than or equal to 5 embryos
89291 - ... greater than 5 embryos
89335 - Cryopreservation, reproductive tissue, testicular
89342 - Storage, (per year); embryo(s)
89343 - ... sperm/semen
89344 - ... reproductive tissue, testicular/ovarian
89346 - ... oocyte
89352 - Thawing of cryopreserved; embryo(s)
89353 - ... sperm/semen, each aliquot
89354 - ... reproductive tissue, testicular/ovarian
89356 - ... oocytes, each aliquot

Review New Panels for Changes
 
When CPT revised the hematology codes in 2003, it deleted 85022 and revised 85025. CPT listed both codes as requirements in the general health panel (80050) and obstetric panel (80055) test codes. CPT 2004 revises the code panels to reflect the 2003 changes as follows:

80050 - General health panel must include:
  

Two new codes appear in CPT 2004 to describe infectious agent antigen detection of giardia by immunofluorescence technique (87269, Infectious agent antigen detection by immunofluorescent technique; giardia) and by enzyme immunoassay technique (87329, Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; giardia). In 2003, you would report these services using 87272 (... cryptosporidium) and 87328 (... cryptosporidium), which CPT 2004 revises to exclude "giardia" from the descriptor language, Tropin says.
 
CPT adds new code 87660 to report the detection of Trichomonas vaginalis by direct probe technique. You may be able to charge separately for handling the vaginal specimen when transferring it to the laboratory by using 99000 (Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory).

Add 2 New Mammography Codes
 
CPT 2004 includes two add-on mammography codes, +76082 (Computer aided detection [computer algorithm analysis of digital image data for lesion detection] with further physician review for interpretation, with or without digitization of film radiographic images; diagnostic mammography [list separately in addition to code for primary procedure]) and +76083 (... screening mammography [list separately in addition to code for primary procedure]), to take the place of the deleted code +76085 (Digitization of film radiographic images with computer analysis for lesion detection and further physician review for interpretation, mammography). You should report 76082 along with the screening mammography code 76092 (Screening mammography, bilateral [two view film study of each breast]), Tropin says. And you will use 76083 along with the existing mammography codes for a unilateral or bilateral mammogram, 76090 (Mammography; unilateral) or 76091 (... bilateral).
 
"The mammography code changes are expected by most folks," says Cindy C. Parman, CPC, CPC-H, RCC, principal and co-founder of Coding Strategies in Atlanta. "Potentially, the most important issue with these codes is the precise definition: 1) the use of computer- aided detection (CAD), 2) digitization is not a determining factor, and 3) documentation of further physician review." From a documentation standpoint, she says, physicians should separate the mammography interpretation from the CAD review to fulfill this requirement.