Ob-Gyn Coding Alert

Pay attention to the modifier indicator to determine which ones you can override and which you can’t.

Every new year brings new, altered, and deleted codes that you must learn in order to keep your ob-gyn’s reimbursement rolling in. And, on the heels of the code changes, the Correct Coding Initiative (CCI) adds to your learning curve by implementing a slew of new bundles.

CCI 19.0, which took effect on January 1, 2013, added 37,587 new bundles and deletes 16, 716. Not surprisingly, many of the new CCI edits target new 2013 CPT^® codes, and ob-gyn wasn’t spared any changes. Read on to find out which CCI changes might affect your coding.

Add These Column 2 Codes to 52287

You will find new Botox bladder injection CPT^® code 52287 (Cystourethroscopy with injection[s] for chemodenervation of the bladder) has a variety of new codes that you should consider included in this service. These column 2 codes include:

Anesthesia 00910 and 00916

Category III codes 0213T, 0216T, 0228T, and 0230T

Wound closure codes 12001-12057, 13100-13153

Intravenous codes 36000, 36405-36406, 36410, 36420-36430, 36440, 36600, 36640

Transcatheter therapy code 37202

Gastic tube placement code 43752

Catheterization codes 51701-51703

Cystoscopic codes 52000, 52001, 52310, 52315

Urethrotomy and meatotomy codes 53000-53025

Urethral dilation codes 53600-53665,

Pelvic exam under anesthesia code 57410.

Injection codes 62310-62311, 62318-62319, 64400-64530

Microsurgical technique code 69990

Fluoroscopic codes 76000-76001, 77001-77002

Echocardiography codes 93000-93010, 93040-93042, 93318

Ventilation and oxygen codes 94002, 94200-94250, 94680-94770

EEG codes 95812-95955

Intravenous codes 96360-96365

Therapeutic injection codes 96372-96376

Moderate sedation codes 99148-99150

Lidocaine HCL injection code J2001

Catheterization for collection of specimen code P9612

"You’ll find 52287 bundles many other codes found in the neurological and medical sections which are rarely if ever coded [by the physician]," says Michael A. Ferragamo, MD, FACS, clinical assistant professor, University Hospital, State University of New York, Stony Brook.

Some of these noted edit pairs have a modifier indicator of "0," which means you cannot separate these edits with a modifier. Others, like the wound closure codes, intravenous and venous codes, and 52001 (Cystourethroscopy and evacuation of multiple obstructing clots), have a modifier indicator of "1." That means that you can use a modifier to override the bundling under specific clinical circumstances.

Get to know 52287: Remember that 52287 is a new code for 2013. Experts have said you should now use this code when your physician performs Botox injections into the bladder detrusor muscle. Previously, you had no specific CPT^® code for Botox bladder injection procedures. Medicare and many other private and commercial carriers had suggested using 53899 (Unlisted procedure, urinary system) for the cystoscopy and bladder wall injections. Now you will use 52287 instead.

Highlight These New G0402, G0438, and G0439 Inclusions

In an ob-gyn practice, you probably report G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment), 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) on occasion.

However, hold off on reporting psychotherapy services (90791-90839). CCI 19.0 bundles psychotherapy services into G0402, G0438, G0439. You can report them separately should you have clinical indication to do so, because these edits have a modifier indicator of "1."

Pay Attention to These Lesser Used Codes, Too

While you may not often use the following codes, there is a chance your ob-gyn will perform the procedures, and you’ll need to know the related CCI bundles.

Column 1 codes 51784 (Electromyography studies [EMG] of anal or urethral sphincter, other than needle, any technique) and 51785 (Needle electromyography studies (EMG) of anal or urethral sphincter, any technique) bundle new 2013 column 2 nerve conduction test codes 95907-95913 and 95940 as well as G0453 (Continuous intraoperative neurophysiology monitoring, from outside the operating room [remote or nearby], per patient, (attention directed exclusively to one patient) each 15 minutes [list in addition to primary procedure]). These edits carry a modifier indicator of "1."

Deletions: These same two codes (51784 and 51785) delete old codes 95900-95936 from your CCI list.

Also, 51715 (Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck) has a new column 2 code, which is 52287 (Cystourethroscopy, with injection(s) for chemodenervation of the bladder). This has a modifier indicator of "1."