Ob-Gyn Coding Alert

Understanding the terminology specific to uro-gynecology can make coders lives easier, as well as ensure proper reimbursement for ob/gyn practices.

Gynecology terminology is different than that of urology, even, at times, for the same procedure, notes Doris Fullerton, CPC, managing director of education and training with MedSafe Inc., a compliance consulting organization in Waltham, MA. When coders have a background in gynecology and then are introduced to urology, they find it difficult at first to understand and code the procedures correctly. Since many ob/gyns nationwide are starting to offer these specialized services, it is crucial to keep informed.

Getting Acclimated to New Terminology

Uro-gynecology is the field of female incontinence. Surgical procedures performed include anterior vesicourethropexy (51840-51841), abdomino-vaginal vesical neck suspension (51845), and sling operation for stress incontinence (57288).

Gynecologists and uro-gynecologists also perform various diagnostic procedures in the office that deal with female incontinence. For example, they might test the urethral sphincter or execute voiding pressure studies in the office. Ob/gyn coders may not have experience in billing for bladder catheterization (51010, 51045), cystometrogram (51725), uroflowmetry (UFR) (51736-51741), urethral pressure profile studies (UPPs) (51772), or voiding pressure studies (51795), says Fullerton. In many instances this is new terminology that a gynecology coder would not recognize.

Fullerton emphasizes the importance of learning not just the procedure codes, but the diagnosis codes as well. We demonstrate medical necessity through diagnosis coding; thats how we communicate with the carrier and get appropriate reimbursement, Fullerton explains. For example, if a patient has uterine prolapse (618.1) with post-void dribbling (788.35), we have to be able to note codes for both conditions. Instead, often only the uterine prolapse is coded. In fact, in the uro-gynecology specialty, multiple codes within each diagnosis might be necessary, including urgency, frequency, and stress incontinence.

Usually, as long as the terminology within the dictated notes is spelled correctly, the correct code can be found to match the terminology, says Lynn Toler, CPC, professional fee coordinator for the University of Washington Physicians, a group of over 600 physicians in Seattle, WA.

One Term, Multiple Codes

Understanding the terminology is often the first and easiest step; but simply being familiar with the terminology does not guarantee that the correct code is assigned.

1. Multiple terms, same procedure: One problem coders face is that physicians can use different terms to refer to a procedure that is given the same CPT terminology (and, therefore, the same code). For example, a simple anterior vesicourethropexy (51840) might be called either a Marshall-Marchetti-Krantz or a Burch procedure by uro-gynecologists. As another example, uro-gynecologists might call a procedure either a Raz or a Stamey, both of which refer to an abdomino-vaginal vesical neck suspension (51845) in CPT terminology.

2. Same term, multiple codes: A second source of confusion is that a uro-gynecologist might use a term that could have multiple possible codes. For example, a Marshall-Marchetti-Krantz procedure might have one of four codes (51840, 51841, 58152, 58267) depending on the procedures complexity and whether a hysterectomy was also performed during the same operative episode.

Remember, its okay to ask questions, counsels Fullerton. When a uro-gynecologist joins a practice, or when a gynecologist begins doing these procedures, he or she should explain the differences to the coders before even doing a procedure. They should explain the most common diagnoses and note the most common procedures. Understanding how to code these procedures can simply be a matter of communication with the surgeons.

Note: For more information on coding urinary incontinence see the February issue of OCA and the article, Coding for the Nonsurgical Treatment of Urinary Incontinence on page 9.