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Ob-Gyn Coding Alert

CCI Analysis:

8.2 Has Some Changes for Ob/Gyns

Published on Thu Aug 01, 2002

New Correct Coding Initiative edits are in effect but the good news is that the new bundles aren't likely to snare savvy ob-gyn coders.

Medicare is still refining the CCI edits, but there are fewer than 30 codes in the female genital system chapter showing any significant bundle additions. In version 8.2, which went into effect July 1, 2002, and remains in effect until Sept. 30, 2002, 50715 (Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis) has been bundled into almost all of the female genital system chapter, and the anesthesia code 00940 (Anesthesia for vaginal procedures [including biopsy of labia, vagina, cervix or endometrium]; not otherwise specified) has been bundled with selected vaginal procedures.

When Can a Code Be Overridden?

The edit can be overridden for 50715 if the documentation shows that the procedure was distinct from the other procedures performed it meets the definition for modifier -59 (Distinct procedural service) but 00940 cannot be billed with any of the comprehensive procedures it is bundled with under any circumstances.
 
In fact, most CCI edits may be overridden by modifiers to indicate that distinct or independent procedures were performed, and that billing with two codes that would normally be bundled is appropriate because of special circumstances. Modifier -59 was created as a response to the CCI edits and overrides most, but not all, bundling combinations. The CCI uses indicators to show which codes  may appropriately use modifier -59 if documentation supports the claim that the procedure was distinct, which usually means it was performed on a separate site or at a different time during the same day.
 
Do not use modifier -59 with coding combinations such as those in the first category of CCI edits or those that are mutually exclusive, that is, a comprehensive procedure that cannot reasonably be reported with a code that is bundled with it. If the codes can be modified, they will have an indicator of 1 beside them in the CCI. If they can't, indicator 0 is shown.

Other Notable Changes

  •  The addition of code bundles for the new codes 58953 (Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking) and 58954 ( with pelvic lymphadenectomy and limited para-aortic lymphaden-ectomy) to reflect the procedures that are included in the code definition
     
  •  Bundling a hysteroscopy with D&C (58558) into all of the codes that describe a hysterectomy that lacked this bundle previously. In most cases, modifier -59 can be used if the documentation supports it as a distinct procedure.  When hysterectomy is performed due to cancer, however, this procedure will always be included.
     
  •  Bundling of the code for intraoperative ultrasound guidance (76986) with the ultrasound guidance codes.

    Minor Changes

     

  • Code 50715 is bundled into codes 57106-57335, 57530-57556, 58140-58285, 58400-58551, 58660-58960
     
  • Code 00940 is bundled into 57106-57460
     
  • Codes 57400, 57410 and 57800 are bundled into 57155 and 58346. These bundles cannot be overridden
     
  • Code 58558 is bundled into 58150-58285, 58951, 58953 and 58954
     
  • Code 58120 is bundled into 58240, 58275, 58280, 58285, 58951, 58953 and 58954
     
  • Code 58100 is bundled into code 58550
     
  • Codes 49200, 49201, 57410, 58150, 58180, 58740, and 58925 are bundled into 58950. These bundles cannot be overridden.

    Extensive Changes

     Bigger changes to the bundles were added to the above comprehensive codes:

    Note: For specific questions about CCI edits, contact the provider-relations staff of your local Medicare carrier or specialty medical society such as ACOG. To order a copy of the CCI, contact the National Technical Information Service (NTIS) at 1-800-553-6847.

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