Ob-Gyn Coding Alert

Make sure you pay attention to the modifier indicator.

Before you consider reporting an obstetric code with an E/M service including 99218, you should check the Correct Coding Initiative (CCI) version 18.2.

The CCI released version 18.2, effective July 1, 2012, revealing 2,521 new active pairs and 88 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in his analysis of the changes. Of the over 2,500 new pairings, 122 had a retroactive effective date of January 1, 2012 while the remaining 2399 went into effect on July 1. All of the code bundle deletions were effective June 30.

Our experts have poured through the changes and have highlighted the ones that will potentially affect your ob-gyn practice. Here's the rundown of what you need to know now.

1. Ob Codes Don't Escape CCI's Notice

If you're used to reporting 59430 (Postpartum care only [separate procedure]), you need to think twice before you report this code with an E/M service. CCI 18.2 bundles all of the office or other outpatient visit codes (99201-99215) into 59430.

"These edits have a modifier indicator of '1' and therefore, can be unbundled with a modifier under specific clinical circumstances," says Michael A. Ferragamo, MD, FACS, clinical assistant professor at the University Hospital, State University of New York, Stony Brook. However, in order to report the E/M service, it would have to be separate and significant from routine postpartum care, and you can only add 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 code to bypass this bundle.

Before you apply 99318 (Evaluation and management of a patient involving an annual nursing facility assessment) with an ob code, you should make certain that this code isn't bundled. The following codes now include the work involved in this evaluation service, if provided:

• 59400 -- Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy and/or forceps] and postpartum care
• 59410 -- Vaginal delivery only [with or without episiotomy and/or forceps]; including postpartum care
• 59510 -- Routine obstetric care including antepartum care, cesarean delivery, and postpartum care
• 59515 -- Cesarean delivery only; including postpartum care
• 59610 -- Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery
• 59614 -- Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); including postpartum care
• 59618 -- Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery
• 59622 -- Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery, including postpartum care.

In all of these cases, the modifier indicator is "1," so you can report 99318 in addition to these codes if you have a modifier and documentation back it up. It would be a very rare situation when a patient who is Medicare eligible finds herself in a nursing home situation long term but not beyond the imaginable. For instance, a severely disabled pregnant patient could have been admitted to a nursing home during her pregnancy, or the patient could have had a stroke early on her pregnancy, which required long term care.

Essential tip: Do not append a modifier to override a CCI bundle just to get paid or because you do not agree with a bundle. You can use a modifier to override a bundle only if your documentation supports using the modifier.

2. Apply These Brachytherapy Edits

If your ob-gyn does the work represented by 57155 (Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy) or 57156 (Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy), then you should be aware of a series of codes that you should count as bundled into these procedures. They are:

• 57156 -- Insertion of vaginal radiation afterloading apparatus for clinical brachytherapy
• 57100 -- Biopsy of vaginal mucosa; simple (separate procedure)
• 57180 -- Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal hemorrhage (separate procedure)
• 57415 -- Removal of impacted vaginal foreign body (separate procedure) under anesthesia (other than local)
• 57530 -- Trachelectomy (cervicetomy), amputation of cervix (separate procedure)
• 58100 -- Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)
• P9612 -- Catheterization for collection of specimen, single patient, all places of service

In all of these cases (except for P9612), the modifier indicator is "0." That means you cannot separate these edits with a modifier (such as 59), no matter what.

3. E/M Visits Now Include These G Codes

If your physician sees a patient and you want to report a patient visit (99201-99215, 99217-99219, 99231-99239) in addition to the following screening, therapy, and counseling G codes -- be forewarned. You have new edits preventing you from doing just that.

Be aware that the following G codes are column 2 codes to the above mentioned E/M codes:

• G0442 -- Annual alcohol misuse screening, 15 minutes
• G0443 -- Brief face-to-face behavior counseling for alcohol misuse, 15 minutes
• G0445 -- High-intensity behavioral counseling to prevent sexually transmitted infections, face-to-face, individual, includes: education, skills training, and guidance on how to change sexual behavior, performed semi-annually, 30 minutes
• G0446 -- Annual face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes
• G0447 -- Face-to-face behavioral counseling for obesity, 15 minutes.

In all of these cases, the modifier indicator is "1," meaning you can separate these edits with a modifier. However, you must have documentation to substantiate breaking this edit.