Ob-Gyn Coding Alert

As always, pay attention to modifier indicators.

You won’t have much to apply to your ob-gyn coding practice from the Quarter 1 edits of the Correct Coding Initiative (CCI) version 22.0, but you should still have a few edits of which you should take note.

Red flag: These edits went into effect January 1, 2016.

1. Thoracic PVB? Consider it Included

Code 56405 (Incision and drainage of vulva or perineal abscess) now includes the work represented by the following codes:

• 61650 — Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory
• 64461 — Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)
• 64463 — Paravertebral block (PVB) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed).

Important: These three codes become column 2 codes into all 56xxx-58xxx and 59xxx codes. In the case of the paravertebral block codes (64461, 64463), the bundles have a “0” modifier indicator, meaning you cannot append a modifier under any circumstance. For the 61650 edits, you have a modifier indicator of “1,” meaning you can use a modifier (such as 59, Distinct procedural service) so long as you have documentation to support its usage. It is highly unlikely, however, that your ob-gyn physician will be administering an agent for thrombolysis and an angrogram.

2. Apply This Edit to New Code 0404T

Remember how CPT^® added new code 0404T (Transcervical uterine fibroid[s] ablation with ultrasound guidance, radiofrequency)? CCI adds this as a Column 2 mutually exclusive code to 58561 (Hysteroscopy, surgical; with removal of leiomyomata). Because the modifier indicator is “1,” then you can apply a modifier to separate this edit—but make certain you have supporting documentation. This would include a completed initial hysteroscopic removal of one fibroid followed by the use of radiofrequency on a separate fibroid, something that would be rare indeed.

3. Observe These Delivery Bundles

If you are tempted to report 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate) with a delivery code (such as, 59400, 59425, 59426), then you need to reconsider. CCI now bundles this code into delivery codes. You can use a modifier to separate this edit, but again, you have to have supporting documentation.

4. Come to Grips With This Ultrasound Guidance Edit

Additionally, you should consider 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) included in 76376 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation) and 76377 (…requiring image postprocessing on an independent workstation).

5. E/M Services Don’t Escape CCI’s Notice

The next set of edits affect the following prolonged services codes:

• 99415 - Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)
• 99416 - Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (List separately in addition to code for prolonged service).

You should consider these codes included in Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) and G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination). All of these edits include a modifier indicator of “1.”

Note: You should also consider these prolonged services codes (99415, 99416) included in 99497.

Finally, your preventive codes (9938x-9939x) and E/M codes (99201-99225) now include ventilation codes (94002-94004, 94660-94662). All of these edits include a modifier indicator of “0,” meaning you cannot separate these edits under any circumstances.