Ob-Gyn Coding Alert

Here’s what to do if you have a retroactive claim these changes affect.

Remember those hysterectomy and A&P repair Correct Coding Initiative (CCI) version 20.3 edits that went into effect October 1 of last year? CMS fixes some of those — and those changes went into effect April 1, 2015. 

Find out how those edits have changed, CMS’s rationale for changing them, and how they will affect you.

For These A&P Repair Edits, Breathe a Sigh of Relief

Last year, Melanie Witt, RN, CPC, COBGC, MA, an independent coding consultant in Guadalupita, N.M. warned that you would find a lot of problems “regarding the particular edit that bundles 57260 (A&P) repair with all vaginal and LAVH hysterectomies with a ‘0’ indicator.

Fortunately, you’ll find that CMS has rescinded some of these edits. No longer do you have to worry about reporting 57260 (Combined anteroposterior colporrhaphy) in conjunction with 58262, 58275, 58285, 58290, 58291, or 58550. CMS states that, “On April 1, 2015, CMS will delete this edit retroactive to October 1, 2014.”

You Will Still Have Some Edits to Contend With

However, you should keep in mind that you will still find the edits bundling 57260 into other procedure codes. 

Important: Also, other edits underwent a change of modifier indicator status. “If you had a denial of any bundled procedure on the list below that had a 0 indicator, but is now retroactively being considered for payment, you should contact your Medicare carrier to find out how they want you to recoup payment,” says Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M. “They may want you to send in a corrected claim, or you may be asked to appeal.  To date, CMS has not issued any transmittal that would indicate they would automatically reprocess these denied services. But keep in mind that a change of an edit from 0 to 1 does not mean you can automatically be paid.  You must meet the criteria for using a modifier to bypass the edit and you should use the CMS rationale for the edit as your guide.”

Here is the breakdown of what changed and what hasn’t, along with CMS’s rationale: