Ob-Gyn Coding Alert

Despite the modifier indicator for this edit, you should follow CPT^® guidelines.

As April rolls around, you need to make certain you’re applying the latest National Correct Coding Initiative (CCI) edits that pertain to your ob-gyn practice — and fortunately, you have only two major areas to highlight.

1. All Ob-Gyn Procedures Include These Add-on Block, Injection Codes

CMS is correcting an oversight in January by adding all of the add-on codes for blocks and injections to the list of bundled codes. These are being added to all ob-gyn procedures:

Take Note: While these codes do not represent procedures that would be performed by an ob-gyn, CMS has bundled them with all codes as they never cover the anesthetic or steroid injection in conjunction with a surgical procedure. “If an obstetrician instead performs an epidural during labor and delivery, the correct codes would be 62322 (Injection[s], of diagnostic or therapeutic substance[s] [eg, anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral [caudal]; without imaging guidance) or 62326 (Injection[s], including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance[s] [eg, anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral [caudal]; without imaging guidance),” says Melanie Witt, RN, MA, an independent coding consultant in Guadalupita, N.M. Neither of these codes have an add-on code for additional levels.

2. Don’t Miss These Myomectomy Edits

In addition, the following edits have also been made. Note that 58674 has been bundled into 58546 (Laparoscopy, surgical, myomectomy, excision; 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g) since January 1, but 58545 was not included at that time.

Heads up: You should note that the 58546/58674 bundle carries a “0” indicator, while the new 58545/58674 bundle has a “1” indicator. However, “coders should note the CPT^® guideline under code 58674, which states you should never bill 58545 with 58674, and that is the instruction you should follow,” Witt says.

Specifically, CPT^® states, “Do not report 58674 in conjunction with 49320, 58541-58554, 58570, 58571, 58572, 58573, 76998.” Since 58545 falls squarely in the prohibited code range of 58541-58554, you should never bill 58545 and 58674 together.