Ob-Gyn Coding Alert

Cystometrograms now include injection codes 64490, 64493.

April 1st brought more than practical jokes. By now, you should have implemented CCI version 17.1's minor changes for ob-gyn practices, which includes edits affecting E/M codes and a urodynamic code.

Background: The Correct Coding Initiative (CCI) 17.1 reveals 11,831 new edit pairs and 346 terminations, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in a March 17 statement.

Highlight What Edits Take Modifier and Which Don't

If your ob-gyn encounters a patient he suspects of alcohol or substance abuse, then you are probably aware of the following codes:

CCI 17.1 bundles these codes into regular E/M codes, including:

Note that the "G" codes are only reported for a structured assessment and intervention service that is performed in the context of the diagnosis or treatment of illness or injury, not as a screening service (which would be the CPT^® codes 99408 and 99409 under Medicare rules). While these "G" codes do allow you to use a modifier to bypass the edits, you should append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service and not the bundled code.

You cannot separate the bundles featuring 99408 and 99409.

Additionally, code 99408 is a component to G0396, and code 99409 is a component of G0397. You cannot separate these edits with a modifier.

Learn New Dynamic to Cystometrogram Code 51726

If your ob-gyn performs urodynamic testing, you should adhere to two new edits. Payers who follow CCI 17.1 will count injection codes 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single level) and 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) as part of 51726 (Complex cystometrogram [i.e., calibrated electronic equipment]).

Don't bother reporting 64490 or 64493 in addition to 51726. These edits have a modifier indicator of "0," meaning that you cannot append a modifier to separate these codes for any reason. Your payer will only reimburse 51726.