Ob-Gyn Coding Alert

The Correct Coding Initiative (CCI) version 14.1, effective April 1, targets only 12 ob-gyn CPT codes with new edits -- and now you-re responsible for putting these edits into practice.

In a nutshell: These bundles fill in the gaps for the pelvic exenteration procedure for gynecologic malignancy (58240), the laparoscopic radical hysterectomy code (58548) added in 2007, and the ovarian, pelvic peritoneal and tubal malignancy codes (58943-58960). The three comprehensive codes with the most changes include 58548 and 58957-58958, the codes for recurrent tumor debulking.

Good news: "Most of the bundles are at least logical given the comprehensive code description, but CCI 14.1 also includes the usual bundles for lysis of adhesions, enterolysis, ureterolysis and exam under anesthesia," says Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based out of Guadalupita, N.M.

Although you can bypass many of the bundles with modifier 59 (Distinct procedural service), you must meet the criteria for doing so. CPT 2008 revised the modifier's descriptor, specifying, "Documentation must support:

- different session

- different procedure or surgery

- different site or organ system

- separate incision or excision

- separate lesion

- separate injury (or area of injury in extensive injuries)."

Remember: Although you can bypass many of the bundles using modifier 59, this is the modifier of last resort. CPT warns that you should not use modifier 59 when another already established modifier is appropriate, unless no more descriptive modifier is available and as long as it best explains the circumstances, says Debra Pierce, MD, MBA, CPC, founder and managing member of Pierce MD Consulting LLC in Rockbridge, Ohio.

The new bundles are in the chart below. The bolded codes represent mutually exclusive procedures.

Code 58548 (Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lympha-denectomy and para-aortic lymph node sampling [biopsy], with removal of tube[s] and ovary[s], if performed) now has 20 new component code bundles and 15 mutually exclusive edits.

Heads up: Even if you can bypass a mutually exclusive edit with a modifier, your carriers will reimburse the lower-valued of the two procedures. All of the mutually exclusive bundles are for codes representing abdominal or vaginal hysterectomy, however, and "you would never bill two surgical approaches to remove the uterus in most cases," Witt says.

The 20 component bundles include lymphadenectomy procedures, myomectomies, endometrial sampling, and laparoscopic work on the tubes or ovaries, as well as fulguration or excision of lesions in the pelvic cavity. Also, 58548 is now a component bundle for 58943-58956.

Second, you should note that 58957 (Resection [tumor debulking] of recurrent ovarian, tubal, primary peritoneal, uterine malignancy [intra-abdominal, retroperitoneal tumors], with omentectomy, if performed) and 58958 (- with pelvic lymphadenectomy and limited para-aortic lymphadenectomy) have the same 25 component bundles in common.

Among them are codes for laparoscopic lympha-denectomy, laparoscopic surgery on the tubes or ovaries, laparoscopic radical hysterectomy, and mesentery lesion removal or abdominal biopsy.

Rationale: The resection codes are open procedures, not laparoscopic. Also, Medicare always bundles biopsies, so "if the ob-gyn is removing the tumor and lots of it, then you would count the biopsy or mesentery lesion as part of the surgery," Witt says.