Ob-Gyn Coding Alert

Find out what laparoscopy code you-ll have to be cautious about using as of July 1

If you want your summer to pass by smoothly, then you need to learn these new enterolysis, laparoscopy and urinalysis bundles. Failure to do so could still land your claim in hot water if you-re not careful. Here's what you need to know by July 1.

Nonmutually Exclusive Edits Target 44005 and 43653

Did you know? Nonmutually exclusive edits pair procedures that you cannot report separately when your physician performs them during the same session. Correct Coding Initiative (CCI) edits establish one procedure of each pair as -comprehensive- and the other as -component.- The -comprehensive- procedure includes the services represented by the -component- code -- which is why you can't submit both procedures on the same claim.

First up on the CCI nonmutually exclusive hit list are 44005 (Enterolysis [freeing of intestinal adhesion] [separate procedure]) and 43653 (Laparoscopy, surgical; gastrostomy, without construction of gastric tube [e.g., Stamm procedure] [separate procedure]). These codes are seemingly unrelated, but CCI 13.2 bundles them into the same list of comprehensive codes.

 They are:

- 49320-49322 (codes for diagnostic laparoscopy, laparoscopy with biopsy and laparoscopy with aspiration)

- 51990-51992 (laparoscopic Burch and sling procedures),

- 58541-58544 (laparoscopic supracervical hysterectomy),

- 58545-58546 (laparoscopic myomectomy),

- 58548 (laparoscopic radical hysterectomy),

- 58550-58554 (laparoscopic-assisted vaginal hysterectomy [LAVH]),

- 58660-58662 (laparoscopic lysis of adhesions, laparoscopic adnexal excision, laparoscopic fulguration of lesions), and

- 58670-58673 (laparoscopic tubal, fimbrioplasty and salpingoneostomy).

What this means to you: If your ob-gyn performs an enterolysis service (44005) and during the same session performs a laparoscopic supracervical hysterectomy (58541-58544), then the only reimbursement you-ll receive is that for the laparoscopic supracervical hysterectomy (58541-58544). You won't have any way around this because CMS applies a modifier indicator of -0.- This means you cannot override the edit pair under any circumstances.

-There's no big surprise here,- says Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M. Both of these procedures are CPT -separate procedures.- CMS tends to bundle these types of codes with all like procedures -- in this case, laparoscopic ones that CPT defines as integral when carried out as part of another total service, Witt says.

No Urinalysis During Global Ob Finalized

You won't find the next edit something to gossip about with your fellow coders, but you should be aware CCI has finally formalized the CPT guideline that states that routine urinalysis is a component of global obstetric care and antepartum care. In the past, -you could not bill these codes anyway because carriers consider them routine,- says Rachel Hollis, CPC, billing manager for Galisteo OB GYN Associates in Santa Fe, N.M.

The urinalysis codes in question are 81000 (Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy) and 81002 (- non-automated, without microscopy).

Bottom line: These two codes are now part of all of the global obstetric package codes and the global antepartum care only codes (59400, 59425, 59426, 59510, 59610 and 59618). All of these edits carry a -0- modifier indicator, meaning you cannot bypass the edit with a modifier.