Ob-Gyn Coding Alert

Heres why you shouldnt panic.

If youre feeling cross-eyed by the Correct Coding Initiative (CCI) version 15.1s release, then help is here.Heres how to narrow the new edits down to 524 unique codes, many of which wont have a huge impact on your ob-gyn coding practices.

First, Take a Large-Picture View

Version 15.1, effective April 1, contains 304,038 additions. The file is one of the largest Ive seen, says Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H, CPCP,CIMC, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.

The official reason CMS has given for the size is a need to control anesthesia bundles.

Break Down Edits That Are New

Good news: The new edits affect most ob-gyn procedure codes with CCI version 15.1 which was effective April 1, 2009 -- but the good news is that the majority of these new edits involve bundling of procedures that involve standard surgical preparation or anesthesia services, says Melanie Witt, RN, COBGC, MA, an independent ob-gyn coding consultant inGuadalupita, N.M. The new bundled edits include:

" Regional anesthesia administered by the surgeon

" Cleaning, shaving, and prepping the skin

" Inserting lines for IV administration of medication

" Inserting urinary catheters

" Inserting and removing drains, suction devices, and pumps in the site of the surgery

" The surgical elements that are integral of the surgical approach, such as identifying anatomical landmarks,exploration, making the incision, and debridement of  raumatized tissue

" Surgical closure and dressings.

In most cases, procedures such as [IV administration] performed during surgery would be included in the main surgical procedure anyway, so these edits shouldnt hurt too badly, says Heather Corcoran, coder with CGH Billing in Lousiville, Ky.

Zero In on ME Edits

In addition to these bundles, CCI has added several new mutually exclusive bundles. This means that if a modifier can be used to bypass the edit, Medicare will reimburse the lowest valued of the two procedures as the primary procedure, Witt says. Translation: You need to be very cautious in billing these combinations. The new mutually exclusive edits for CCI version 15.1 are:

In addition, all of the laparoscopic supracervical hysterectomy codes (58541-58544) now bundle:

" 57020 (colpocentesis)

" 57100 (biopsy of the vaginal mucosa)

" 57400 (dilation of the vagina)

" 57415 (removal of impacted vaginal foreign body)

" 57420 (vaginal colposcopy)

" 57452 (cervical colposcopy)

" 57500 (cervical biopsy)

" 57530 (trachelectomy)

" 57800 (cervical dilation).

Bonus: These same codes are also bundled into the other laparoscopic hysterectomy codes 58548 (Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling [biopsy], with removal of tube[s] and ovary[s], if performed), codes 58550-58554 (LAVH), and codes 58570-58573 (TLH).

Finally, CCI 15.1 bundles the codes for enterolysis (44005, 44180), omentectomy (49255), and adhesiolysis (58660) into codes 57284 (Paravaginal defect repair [including repair of cystocele, if performed]; open abdominal approach) and 57423 (Paravaginal defect repair (including repair of cystocele, if performed),laparoscopic approach).