Ob-Gyn Coding Alert

Also, vaginal hysterectomy codes specifying "with repair of enterocele" got common sense bundles.

Submitting a claim with annual wellness visit codes G0439 or G0438 has just gotten a lot trickier, thanks to the Correct Coding Initiative version 17.2. Check out these numerous edits as well as some affecting vaginal hysterectomies, pelvic exenteration procedures, and fetal invasive procedures including ultrasounds.

CCI version 17.2, which takes effect July 1, offers 2,367 new edit pairs and deletes 336 bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC. The majority of edits impact the codes from the musculoskeletal code range (20000-29999), but bundles did occur to codes throughout the CPT® manual.

Avoid AWV With Health/Behavior Assessment

Most edits of interest to ob-gyn physicians center on AWV codes G0438 (Annual wellness visit; includes a personalized prevention plan of service [PPS], initial visit) and G0439 (Annual wellness visit; includes a personalized prevention plan of service [PPS], subsequent visit).

Explanation: Because the AWV is a preventive wellness visit, many of its components overlap with the health and behavior assessment/intervention codes (96150-96154) and medical nutrition therapy (MNT) codes (97802-97804). The new CCI edits clarify that CMS will no longer allow you to report any of these codes with an AWV. If you do report the services together, you'll collect for the AWV but not for the assessment or MNT. The edits don't allow you to separate these pairings under any circumstances.

AWV With E/M Could Be Legit -- With Modifiers

The status of AWVs with E/M visits brings better news. CCI 17.2 bundles office visit codes 99201-99215 into both G0438 and G0439, but don't lose hope. You can append a modifier (such as 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 code if you have a medically necessary reason to separate these bundles, and be paid for both services.

Remember: CMS already requested that you append modifier 25 when reporting an E/M code with an AWV. CMS Transmittal 2159, issued on Feb. 15, noted, "When the physician or qualified NPP, or for AWV the health professional, provides a significant, separately identifiable medically necessary E/M service in addition to the IPPE or an AWV, CPT® codes 99201-99215 may be reported depending on the clinical appropriateness of the circumstances. CPT® Modifier 25 shall be appended to the medically necessary E/M service . ..."

CMS went on to remind practices not to double dip for any AWV and E/M services, stating, "Some of the components of a medically necessary E/M service (e.g., a portion of history or physical exam portion) may have been part of the IPPE or AWV and should not be included when determining the most appropriate level of E/M service to be billed for the medically necessary, separately identifiable, E/M service."

Note: The language from CMS Transmittal 2159 above has been incorporated into Section 30.6.1.1(h) of Chapter 12 of the Medicare Claims Processing Manual. The new edition of CCI simply makes the previous statements official by including the change in edits.

You Won't Report 58240 With These Codes

You won't be reporting 58240 (Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube[s], with or without removal of ovary[s)...), with removal of bladder and ureteral transplantations and/or abdominoperineal resection of rectum and colon, colostomy, or any combination of these procedures.

Bundled codes with no ability to bypass edit with a modifier are as follows:

A modifier indicator of "0" means that you cannot separate these edits under any circumstances using a modifier.

CCI 17.2 Hits Hysterectomy Codes

Vaginal hysterectomy codes 58263, 58270, 58280, 58292, and 58294 did not escape CCI 17.2's notice.

For instance, you cannot report 58263 (Vaginal hysterectomy, for uterus 250 g or less; with removal of tube[s], and/or ovary[s], with repair of enterocele), 58270 (Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele), 58280 (Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele), 58292 (Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube[s] and/or ovary[s], with repair of enterocele), and 58294 (Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele) with 57270 (Repair of enterocele, abdominal approach [separate procedure]). This shouldn't come as a surprise, as all of these vaginal hysterectomy codes include the phrase "with repair of enterocele" in their descriptors.

Additionally, you cannot report 58280 and 58292 with 45560 (Repair of rectocele [separate procedure]). Like the above edits, these edits also carry a modifier indicator of "0," meaning that you cannot separate them under any circumstances with a modifier. And the reason for this edit? Code 45560 is a CPT® "separate procedure." So make sure that if your physician is repairing a rectocele at the time of hysterectomy, you are reporting the posterior colporrhaphy codes for this, not the code contained in the digestive system (which is meant to be used by general surgeons for repair of a rectocele causing fecal incontinence via rectal tissue plication).

Tack On Two More Bundles to 59897

If you commonly report 59897 (Unlisted fetal invasive procedure, including ultrasound guidance, when performed), then you should be aware of two new bundles.

You should pause before submitting 59897 with 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) or 76998 (Ultrasonic guidance, intraoperative) -- but you can report them together, should the ob-gyn provide sufficient documentation to support this. In other words, you can only bill one of these codes in addition to 59897 if the ob-gyn used the guidance for some other purpose than to guide the fetal invasive procedure.

These edits carry a modifier indicator of "1," meaning you can separate them with a modifier 59 (Distinct procedural service).

To read more about CCI coding, visit the CMS Web site at www.cms.gov/NationalCorrectCodInitEd/.