Ob-Gyn Coding Alert

Tip: Make certain you understand what “mutually exclusive” really means.

The codes for excision of benign and malignant lesions of the external genitalia (11421-11426, 11620-11626) are bundled into the new code 10030 (Image-guided fluid collection drainage by catheter [e.g., abscess, hematoma, seroma, lymphocele, cyst], soft tissue [e.g., extremity, abdominal wall, neck], percutaneous).

While these bundles allow for use of a modifier to bypass the edit, they are considered mutually exclusive.

Remember: If CCI bundles procedures as “mutually exclusive” (ME), modifier 59 (Distinct procedural service) may apply. But, if you use modifier 59 to separate ME edits, Medicare will reimburse the lower-valued procedure in full but will reduce the higher-valued procedure by 50 percent. Therefore, most coding experts recommend that in the rare cases that you perform two procedures together that CCI denotes as mutually exclusive, you should normally report the higher-valued code only.

New code 49407 (Image-guided fluid collection drainage by catheter [e.g., abscess, hematoma, seroma, lymphocele, cyst]; peritoneal or retroperitoneal, transvaginal or transrectal) is bundled into 58822 (Drainage of ovarian abscess; abdominal approach).

Again, you can bypass this bundle with a modifier, but this is a mutually exclusive edit. In other words, Medicare will reimburse the lower valued procedure at the full allowable but discount the higher valued procedure.