Ob-Gyn Coding Alert

Overlooking these new Interstim and hemorrhoid destruction bundles could mean denial headaches.

Don't let CCI version 16.1's lack of ob-gyn mutually exclusive edits lull you into a false sense of security. Here's what you need to know to prevent a denial from landing on your desk.

Payers like Noridian Part B will cover the female stress urinary incontinence treatment code 0193T, but before you submit a 0193T claim, you'll have to check with the Correct Coding Iniative (CCI) version 16.1's edits. For instance, as of April 1, the work represented by 0193T will include that of cystourethroscopy codes 52000-52001 and 52281.

1. Look For 0193T in Both the Column 1, Column 2 Position

In 2009, CPT added 0193T (Transurethral, radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence) to your possible stress urinary incontinence (SUI) treatment coding options. This code includes the Renessa transurethral collagen radiofrequency denaturation procedure. Ob-gyns typically perform this nonsurgical, minimally invasive alternative for women who have failed other nonsurgical treatments or who aren't good candidates for surgery.

What happens: The ob-gyn uses controlled heat at low temperatures and targets tissue in the woman's lower urinary tract. The heat changes the structure of the patient's natural tissue collagen. This helps the firmness of tissue and improves her continence. Although the ob-gyn may use heat on multiple sites and document multiple cycles, you should report 0193T once to represent all the treatment cycles performed during an encounter.

As of April 1, 0193T will include the work represented by 52000-52001 (Cystourethroscopy ) and 52281 (Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female).

Reaction: "These edits don't surprise me at all because 0193T says 'transurethral' which implies the use of the scope," says Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis. For instance, you should always include "inserting the scope (52000) into the major procedure." As for 55281, "that is a little less obvious," but CCI "probably bundled that because these services may be part of the approach," Rasmussen adds.

You should also include 53660-53666 (Dilation of female urethra ) and 90901 (Biofeedback training by any modality). CCI describes these edits as "misuse of column 2 code with column 1 code" (0193T). Remember: Column 1/column 2 edits describe "bundled" procedures. The column 1 code generally represents the comprehensive service, and the column 2 code is the component that is part of the more extensive column 1 procedure, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, consultant with MJH Consulting in Denver.

All of these edits carry a modifier indicator of "1,"meaning you can use a modifier (such as 59, Distinct procedural service) to separate them -- but make sure your documentation supports the modifier.

Additionally, as of April 1, you should do the opposite and bundle 0193T into the following services:

51845 -- Abdomino-vaginal vesical neck suspension,with or without endoscopic control (e.g., Stamey, Raz, modified Pereyra)

51990 -- Laparoscopy, surgical; urethral suspension for stress incontinence

51992 -- sling operation for stress incontinence (e.g., fascia or synthetic)

57160 -- Fitting and insertion of pessary or otherintravaginal support device

57288 -- Sling operation for stress incontinence (e.g., fascia or synthetic).

CCI describes these bundles as "misuse of column 2 code" (which is 0193T) "with column 1 code." Again, all of these edits carry a modifier indicator of "1," meaning you can use a modifier to separate it -- but make sure your documentation supports the modifier, or you'll face a denial.

2. Take Note of New Fluoroscopy Bundle With Interstim Procedure

If your ob-gyn tests electrodes for the Interstim procedure, you're probably used to reporting 64561 (Percutaneous implantation of neurostimulator electrodes; sacral nerve [transforaminal placement]).

What you may not be used to is including fluoroscopy codes (76000-76001, Fluoroscopy ; 77002-77003, Fluoroscopic guidance ). CCI 16.1 tacks these codes as column 2 codes with a modifier "1" indicator, which means you'll have to append  -- and justify -- a modifier onto the fluoroscopy code to separately report both procedures.

Reaction: Notice how 64561 contains the term "percutaneous." The physician "has to have some way to visualize the placement," Rasmussen points out.

3. Count 46930 as Part of More Extensive Hemorrhoid Procedure

Do you report 46930 (Destruction of internal hemorrhoid[s] by thermal energy [e.g., infrared coagulation, cautery, radiofrequency]) with any regularity? If so, then you should be wary of reporting this code with 46255-46258 (Hemorrhoidectomy ), which are "more extensive procedures," according to CCI.

You cannot separate these bundles with a modifier under any circumstance -- except for the case of 46258 (Hemorrhoidectomy, internal and external, single column/ group; with fistulectomy, including fissurectomy, when performed) with 46930. In this one case, you can use a modifier if necessary, but you have to have documentation to back this up.

You shouldn't report 46930 with 46500 (Injection of sclerosing solution, hemorrhoids) -- a code combination you shouldn't be reporting anyway. Because this edit carries a modifier indicator of "0," you cannot separate this bundle with a modifier under any circumstance.