Ob-Gyn Coding Alert

Bonus: Find out if you will get paid for this non-face-to-face service.

Every Jan. 1 brings code changes, and every new year the Correct Coding Initiative (CCI) adds non-mutually exclusive edits to the new codes featured in CPT® 2014.

“As is customary for the first update of a given year, there are a lot of new edit pairs: 61,120 to be exact,” says Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. “Factor in the number of terminations (13,107) and we see a net gain this coming quarter of 48,013 new edit pairs.”

For ob-gyn coders, the version 20.0 edits bring several edits that may affect your claims. Read on to learn about the phone/Internet consultation code and image guided fluid collection services that you need to apply to your Q1 coding.

Can You Be Paid For Interprofessional Consults? CCI Says No

Medicare has bundled all of the new Interprofessional consultation codes into all gynecologic surgeries, the urodynamic testing codes, and all obstetric procedures, and all of the obstetric and gynecologic ultrasound procedures. The bundled codes are 99446-99449.

Rationale: This reflects Medicare’s policy of never paying for non-face-to-face services or consultations.

“With relatively few exceptions, the modifier indicator associated with these edit pairs is ‘0,’ so you will not be able to override the edit with a modifier,” observes Kent Moore, Senior Strategist for Physician Payment at the American Academy of Family Physicians. “Since the inter-professional consultation code is the Column 2 code in each case, it will be the code that is denied in favor of the procedural code reported on the same date,” adds Moore. So, if you are planning on reporting these codes separately with any other procedural codes, you’ll have to check CCI edits to see if these codes are paired.

Reminder: CCI 20.0 also pairs these codes as Column 2 codes with E/M service codes. So, you cannot report these codes if you are reporting any other E/M service code for the same session also. Note that these pairings also carry the modifier indicator ‘0’ which means that you cannot undo these edits by using any modifiers.

Example: Your ob-gyn sees a 35-year-old new patient for complaints of abdominal pain. The patient was being seen by another physician in another state. But the other physician was unable to manage and monitor the patient as the patient transferred out of that state. Your ob-gyn sees the patient, reviews previous records and test results, and records a complete history of the patient. He also performs an examination of the patient and orders some blood tests, which are done while the patient is in the office.

After receiving the results of the tests, your ob-gyn discusses the patient’s condition and treatment/management options that were performed by the previous physician by making a call to that physician on the same day.

Your physician discusses the management options that were followed by the previous physician and provides information about the present blood sugar levels; he also discusses further treatment options with the previous physician. Your physician spends a total of 15 minutes over the phone discussing the patient with the other physician.

Since you report the evaluation of the patient with a new patient E/M code for the session, you will not be able to report the time spent by physician on the same date in discussion with the other physician about the patient’s condition with 99447 (Inter-professional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 11-20 minutes of medical consultative discussion and review) as CCI 20.0 bundles the E/M code and 99447 with the modifier indicator ‘0.’

Heads up: They have also permanently bundled the two transitional management codes (99495-99496) into all surgical procedures as well.

You Can Report A Modifier to Bypass This New Code Bundle

New codes 49406 and 49407 are bundled into the following codes, but you can use a modifier to bypass the edit if you meet the criteria for using it.

You should consider new code 49406 (Image-guided fluid collection drainage by catheter [e.g., abscess, hematoma, seroma, lymphocele, cyst]; peritoneal or retroperitoneal, percutaneous) as bundled into 58805 (Drainage of ovarian cyst[s], unilateral or bilateral [separate procedure]; abdominal approach) and 58822 (Drainage of ovarian abscess; abdominal approach).

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 the following codes:

• 57000, Colpotomy; with exploration,
  
• 57101, Colpotomy; with drainage of pelvic abscess,
  
• 57020, Colpocentesis (separate procedure),
  
• 57022, Incision and drainage of vaginal hematoma; obstetrical/postpartum,
  
• 57023, Incision and drainage of vaginal hematoma; non-obstetrical (e.g., post-trauma, spontaneous bleeding),
  
• 57265, Combined anteroposterior colporrhaphy; with enterocele repair,
  
• 57268, Repair of enterocele, vaginal approach (separate procedure),
  
• 58275, Vaginal hysterectomy, with total or partial vaginectomy,
  
• 58280, Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele,
  
• 58285, Vaginal hysterectomy, radical (Schauta type operation),
• 58800, Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure); vaginal approach,
• 58820, Drainage of ovarian abscess; vaginal approach, open,
• 59400, Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care.

Remember, to bypass an edit, you must add a modifier to the Column 2 code, but make sure you have supporting documentation.

Forget A Modifier For These Edits

Both of these new codes (49406 and 49407) are permanently bundled into the following codes, but in these instances, no modifier can be used to bypass the edit.

New code 49406 is permanently bundled into:

• All of the open abdominal procedure codes (58150-58240),
  
• 58600, Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral,
  
• 58605, Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure),
  
• 58615, Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach,
  
• 58720, Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure),
  
• 58740, Lysis of adhesions (salpingolysis, ovariolysis),
  
• 58750, Tubotubal anastomosis,
  
• 58752, Tubouterine implantation,
  
• 58760, Fimbrioplasty,
  
• 58770, Salpingostomy (salpingoneostomy), 58820, Drainage of ovarian abscess; vaginal approach, open,
  
• 58825, Transposition, ovary(s), 58920, Wedge resection or bisection of ovary, unilateral or bilateral,
  
• 58925, Ovarian cystectomy, unilateral or bilateral,
  
• 58940, Oophorectomy, partial or total, unilateral or bilateral,
  
• 58943, Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal or primary peritoneal malignancy, with para-aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal biopsies, diaphragmatic assessments, with or without salpingectomy(s), with or without omentectomy, 58950, Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy,
  
• 58951, Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy,
  
• 58952, Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with radical dissection for debulking (i.e., radical excision or destruction, intra-abdominal or retroperitoneal tumors),
  
• 58953, Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking,
  
• 58954, Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy,
  
• 58956, Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy,
  
• 58960, Laparotomy, for staging or restaging of ovarian, tubal, or primary peritoneal malignancy (second look), with or without omentectomy, peritoneal washing, biopsy of abdominal and pelvic peritoneum, diaphragmatic assessment with pelvic and limited para-aortic lymphadenectomy.
  

New code 49407 is permanently bundled into:

• 58262, Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s)
  
• 58263, Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele,
  
• 58291, Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s),
• 58292, Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele.