Ob-Gyn Coding Alert

Learn why you have reason to both cheer and lament sling procedure edits As of Jan. 1, you should be using new CPT 2008 ob-gyn codes -- but learning what they are and when you should report them isn't often the end of the story. The Correct Coding Initiative (CCI), version 14.0, applies a slew of bundles to your daily coding practice and limits what services you can report in conjunction, thanks to two new codes for paravaginal repairs and four new codes for laparoscopic hysterectomies. 1. Get the Good and Bad News for Sling Procedure Edits For many years, you-ve had to take into account that a sling procedure (57288, Sling operation for stress incontinence [e.g., fascia or synthetic]) is a component of the only existing code for a paravaginal defect repair: 57284 (Paravaginal defect repair [including repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse]). However, CPT 2008 revised 57284 to make this an open procedure that includes only a cystocele repair: Paravaginal defect repair (including repair of cystocele, if performed); open abdominal approach. CPT 2008 also added two new codes to represent the vaginal (57285, - vaginal approach) and laparoscopic approaches (57423, Paravaginal defect repair [including repair of cystocele, if performed], laparoscopic approach). Therefore, "CCI made some changes to the existing bundles for code 57284, which brings about both good and bad news," says Melanie Witt, RN, CPC-OGS, MA, a coding expert based out of Guadalupita, N.M. Bad news: Like before, you-ll still have to count a sling procedure (57288) as a component to 57284. Also, CCI 14.0 now includes 57284 in these services: - 57265 -- Combined anteroposterior colporrhaphy; with enterocele repair - 58152 -- Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (e.g., Marshall-Marchetti-Krantz, Burch) - 58267 -- Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control. Don't miss: You should take into account that 51990 (Laparoscopy, surgical; urethral suspension for stress incontinence) and 57260 (Combined anteroposterior colporrhaphy) are now components of 57284. Good news: The good news is you can report the sling procedure (57288) with the new paravaginal repair codes (57285 or 57423). "The American College of Obstetricians and Gynecologists (ACOG) is working to have the sling bundle with code 57284 remedied for CCI 14.1," Witt says. In a nutshell: For this reason, you must know the approach of the paravaginal repair before assigning the code, says Lana Flatt, CPC, office manager of OB/GYN Associates in Cookeville, Tenn. You will be able to report the sling procedure (57288) if the ob-gyn performed a vaginal approach or laparoscopic paravaginal defect repair. 2. CCI Backs Up [...]