Ob-Gyn Coding Alert

Ob/gyn coders frequently discuss the challenges of coding for Medicare screening Pap and pelvic exams. But other Medicare services such as mammograms, colorectal screening tests and bone density studies are likely performed by ob/gyns and test the coders' skills as well. Melanie Witt, RN, CPC, MA, an ob/gyn coding expert and educator who lectures nationally on Medicare coding and reimbursement, presents guidelines for overcoming the coding problems associated with screening benefits for these services, and offers some simple rules for determining the frequency of testing and the right diagnostic codes. Typical Services In addition to screening Pap and pelvic/breast exams (G0101 [Cervical or vaginal cancer screening; pelvic and clinical breast exam] and Q0091 [Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory]), Medicare patients may see their ob/gyn for several of the following services, especially if the ob/gyn is also providing primary care:
bone density studies mammography colonoscopy sigmoidoscopy occult blood testing. Because Medicare's policy is not to pay for "preventive" care, these are considered "screening" services, or "those services rendered in the absence of an illness, disease, or symptom." "The frequency with which Medicare will pay for these services is determined by the patient's risk category," Witt explains. Bone Density Studies Used to check for osteoporosis, bone density studies are payable by Medicare for a number of reasons, but the one closest to a true "screening" exam is when the patient is documented as estrogen-deficient. The study will be reimbursed every two years if the documentation clearly shows that the patient is estrogen-deficient by medical history or other findings. Medicare carriers have identified the following diagnoses as showing estrogen deficiency: 256.2 Postablative ovarian failure 256.31 Premature menopause 256.39 Other ovarian failure 627.2 Menopausal or female climacteric states 627.4 States associated with artificial menopause 627.9 Unspecified menopausal and postmenopausal disorder. Depending on local Part B carrier rules, submit one of the following codes for the bone scan: 76075 Dual energy x-ray absorptiometry (DEXA), bone density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine) 76076 appendicular skeleton (peripheral) (e.g., radius, wrist, heel) 76078 Radiographic absorptiometry (e.g., photodensitometry, radiogrammetry), one or more sites 76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method 78350 Bone density (bone mineral content) study, one or more sites; single photon absorptiometry. Or: G0130 Single energy x-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) G0131 Computerized tomography bone mineral density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine) G0132 Computerized tomography bone mineral density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel). You should note that although G0131 and G0132 are [...]