Ob-Gyn Coding Alert

Forgo including four fluoroscopy codes, especially when submitting "scopy" procedures.

With the new year comes 698,042 new Correct Coding Initiative (CCI) version 17.0 edits, but don't panic. Most of the edits affecting your ob-gyn claims won't be difficult to apply to your daily coding practice.

For instance, if you're already comfortable with bundles that exist for 57155 (Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy), then you're prepared for the new bundles added to new code 57156 (Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy). They are the same.

Break the rest of the edits into two categories: fluoroscopy edits and E/M edits.

1. Count 4 Fluoro Codes As Included in Gyn Procedures

Your claims could face problems if you attempt to bill a fluoroscopic code in addition to "just about everything in the gynecology section in the CPT manual," says Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M.

In particular, CCI 17.0 highlights the following four fluoroscopic codes:

• 76000 -- Fluoroscopy (separate procedure), up to 1 hour physician time, other than 71023 or 71034 (e.g., cardiac fluoroscopy)
• 76001 -- Fluoroscopy, physician time more than 1 hour, assisting a nonradiologic physician (e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)
• 77001 -- Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)
• 77002 -- Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device)

In essence, CCI 17.0 "bundles 76000, 76001, and 77001 into some codes and only 77001 and 77002 into others. No rhyme, no reason," Witt says. "Essentially, CCI 17.0 is telling you not to bill fluoroscopy separate from any scope procedure (such as, colposcopy, laparoscopy for hysteroscopy, and so on)."

2. Break Down These E/M Edits

With a broad brush stroke, CCI 17.0 bundles E/M services into all delivery and delivery plus postpartum care codes (59400, 59410, 59510, 59515, 59610, 59614, 59618 and 59622). These edits carry a modifier indicator of "1," meaning that you can separate these bundles with a modifier so long as you can show these encounters are separately identifiable. "Remember, these delivery and delivery plus postpartum care codes already include admission, subsequent hospital care, discharge, and postpartum care under CPT guidelines," Witt says.

However, what is new is that you should now include observation care, which has not been a part of routine ob care in the past. Also, you should include the nursing facility care, rest home care, and home care visits -- which make no sense for ob patients anyway, Witt says.

Antepartum care only codes 59425 (Antepartum care only; 4-6 visits) and 59426 (... 7 or more visits) did not escape CCI 17.0's notice. These codes now include 99201-99215 (Office or other outpatient visit ...). Again, you can separate these edits with a modifier, but be sure to include documentation to show payers how these services are separately identifiable. Remember, "these bundles apply to the same date of service, so it is unlikely that you would bill antepartum care and a separate E/M code on the same date of service unless the E/M service was not related to pregnancy," Witt adds.

Finally, observation care (99217-99220, Initial observation care, per day, for the E/M of a patient ...) is now part of G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) and Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory).